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Handbook for Managers of GP Training Practices:
Managing the GP Trainee
Authors: Linda Cross
Kathy Platts Keleigh Atkin
Viv Longdon Editor: David Poll
April 2015
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Handbook for Managers of GP Training
Practices: Managing the GP Trainee
Contents
WHAT ARE TRAINEES? .............................................................................................................. 5
The Local Education and Training Board....................................................................5
Innovative Posts....................................................................................................................... 5
Trainee Employment…………………………………………...................................................................6
General Medical Council ........................................................................................................6
Recruitment………………………........................................................................................................ 6
Becoming a Training Practice ........................................................................................... 7
MRCGP................................................................................................................................................. 7
Applied Knowledge Test (AKT) ........................................................................................ 7
Clinical Skills Assessment (CSA)..................................................................................... 8
Workplace-based Assessment.......................................................................................... 8
ePortfolio ...................................................................................................................................... 9
Reviews of progress ............................................................................................................... 9
Educational and clinical supervision ............................................................................ 9
INDUCTION.................................................................................................................................... 10
Induction..................................................................................................................................... 10
Induction Pack......................................................................................................................... 10
CONTRACT OF EMPLOYMENT............................................................................................... 11
Terms and Conditions of Service .................................................................................. 11
Salary and Allowances ........................................................................................................ 12
Pension Contributions ......................................................................................................... 12
Professional Registration and Indemnity................................................................ 12
Transport..................................................................................................................................... 12
Annual Leave ............................................................................................................................ 12
Maternity Leave ...................................................................................................................... 13
Additional Leave ..................................................................................................................... 13
Less than full time working (less than full time - LTFT) ..................................13
Timetable .................................................................................................................................... 14
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Independent Study ............................................................................................................... 14
Tutorials....................................................................................................................................... 15
Study Leave ............................................................................................................................... 14
GP TRAINEE WORK PLAN ...................................................................................................... 14
GP TRAINEE EDUCATIONAL PLAN .................................................................................... 15
Tutorials....................................................................................................................................... 16
GP Locality Training Programme half day release ............................................. 16
Independent study ................................................................................................................ 16
Approaches to learning ...................................................................................................... 16
PRACTICE MANAGER INPUT INTO TRAINING........................................................... 17
Implications of the MRCGP............................................................................................... 17
TRAINEES and FINANCE ........................................................................................................ 19
GP Trainee Salary................................................................................................................... 20
Vehicle Allowance .................................................................................................................. 21
Summary Check List ............................................................................................................. 21
PRACTICE POLICIES ................................................................................................................. 22
GP Trainee’s Handbook ...................................................................................................... 22
Complaints ................................................................................................................................. 22
Critical Incidents .................................................................................................................... 22
INFORMATION MANAGEMENT AND TECHNOLOGY ................................................. 23
Management Information ................................................................................................. 23
Non-clinical system computer use............................................................................... 23
Use of internet and email .................................................................................................. 23
Data Protection ....................................................................................................................... 24
Caldicott Guardian ................................................................................................................. 24
PRACTICE ORGANISATION................................................................................................... 24
Consulting Rooms .................................................................................................................. 24
Medicines Management ...................................................................................................... 25
Library........................................................................................................................................... 25
Access and appointments ................................................................................................. 25
Consent for recording of consultations .................................................................... 26
OUT OF HOURS ............................................................................................................................ 26
PRACTICE MEETINGS AND GP TRAINEE INVOLVEMENT........................................27
Prior to the Practice Meeting .......................................................................................... 27
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The Practice Meetings ......................................................................................................... 27
EQUIPMENT THE GP TRAINEE WILL NEED.................................................................. 28
Consulting Room .................................................................................................................... 28
Drugs ............................................................................................................................................. 29
Controlled drugs ..................................................................................................................... 29
USEFUL URLs................................................................................................................................. 29
GO Training Programme Managers .............................................................................30
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WHAT ARE TRAINEES?
General Practitioner Specialist Trainees (GPSTs) are defined as qualified medical
practitioners who are being trained in General Practice. The training programme starts once 2 years of Foundation Programme posts (or their equivalent) have been completed.
Trainees usually need to complete three years specialty training which includes 18
months as a trainee in an approved training practice, with a further 18 months in
approved specialty posts. They must spend 12 months in a training practice at the end,
so the other posts are spread throughout their first two years.
GP is a specialty, so the trainees are called Specialist Trainees and so ST 1 in their first
year, then ST2 and ST3.
An example of a training programme is as follows:-
ST1 4 months in paediatrics 4 months in GP 4 months in medicine
ST2 4 months in A/E 4 months in GP 4 months in psychiatry
ST3 12 months in GP
The trainees are based in localities across the East Midlands
The Local Education and Training Board
Local Education and Training Boards (LETBs) are responsible for the education and
training of health and public health workers at a regional level. They are committees of
the national body, Health Education England (HEE).
The East Midlands Local Education and Training Board (LETB) has eight training centres with programme offices at:
Chesterfield Derby
Clumber Park
Sherwood Forest
Nottingham
Lincoln Boston
Leicester (covering Leicester, Northampton and Kettering). Each centre has a programme manager and it helps to get to know yours. Each
programme also has some programme directors who are GPs who direct and support the
trainees and trainers in their locality. Access to contact details and other information
regarding the programmes is at https://www.eastmidlandsdeanery.nhs.uk/page.php?id=841 What used to be known as Vocational Training stopped in 2008 and was replaced by the
organisation of training programmes. Sometimes you will still hear of the “Locality GP
Training Programme” and “The VTS”.
Innovative Posts
Sometimes posts arise to allow the GP Trainee, whilst based in General Practice, to have
other educational attachments outside General Practice. They enable GP Trainees to have a broader experience than may have been possible under a standard three year
programme.
The posts run differently in the various training programmes. Usually they are during the
GP post in ST2 and will involve spending up to half the week in either another specialty
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or management or educational environment.
These trainees remain employees of the practice during this time but hold honorary contracts in the other posts.
Trainee employment
GPSTs, when in practice are the employees of the practice. They hold the contract of
employment and funding for the posts is provided by Shared Business Services (SBS)
who dictate the salary of the trainee, the pension contributions and the contribution for
medical insurance and expenses. They are subject to the disciplinary processes at the
practice as any other employee but their particular employment conditions are best
managed using the GPST contract negotiated with the BMA. General Medical Council
The GMC defines its role as being an independent statutory body with responsibility for
promoting the development of postgraduate medical education and training for all
specialties in the UK, including General Practice. The GMC defines its responsibilities as:
Establishing standards and requirements for postgraduate medical education and training.
Making sure these standards are met.
Developing and promoting postgraduate medical education and training across
the country.
The GMC carries out the following roles:
Approving standards for assessments, trainers and programmes for the delivery
of postgraduate medical education and training. The LETB ensures the training
standards are met through its trainer approval and re-approval process.
Monitoring training, quality standards and outcomes through inspection visits and other arrangements if necessary.
Awarding Certificates of Completion of Training (CCT).
Determining the eligibility of doctors for inclusion on the Specialist and GP
Registers.
Further information can be found at http://www.gmc-uk.org In summary the current route for a qualified medical practitioner, after Foundation
training, is as follows:
Apply to a three year GP Training Programme centrally via Konetic.
Successful applicants will be allocated to a GPTP, and will undergo three years of
training as GP Trainees.
During this period they will be continually assessed, and the ePortfolio confirming
appropriate standards have been achieved will be available to the GMC so that a
Certificate of Completion of Training can be awarded.
Recruitment
All applications for GPTP are handled nationally by the National Recruitment Office
http://gprecruitment.hee.nhs.uk/. The NRO ensures that all GPSTs meet a certain level of competence before acceptance onto a training programme. Trainees usually select the
locality training programme to which they wish to belong and can opt for their own
specific cycle of posts as a training programme.
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Appointment to a training practice is done via the locality programme and no further
interviews take place. Although the trainee will be an employee of the practice, the practice does not get involved in any further appointment process.
Becoming a Training Practice
Practices wishing to become training practices should, in the first instance, contact their
locality training programme. Practices must meet the required standards but individual
trainers are approved. Ideally, they are looking for practices that reflect the cutting edge
of primary care, which is important because “such practices furnish registrars with a
period of practical experience under the supervision of trainers who are skilled clinicians
and teachers. They also provide the facilities and atmosphere to encourage registrars to
read critically and widely, and establish their professional values”. The most important
attribute, however, is enthusiasm for GP and a commitment to support the needs of GPs
of the future. Because it is expected that GP Trainees will be given wide and varied experience, the
whole Practice needs to make a commitment to training, meaning that it is not just
partners, but other team members who need to participate in the training of the GP
Trainee. GPs who are going to become trainers will need to take part in a training course and
pass a number of assessments before they can be accepted on to the course. They need
to be re-accredited after the first year and thereafter every three years. The Practice
also undergoes an assessment of suitability to be a training practice. MRCGP
The Royal College of General Practitioners website gives details of the new MRCGP, the
test process that registrars need to pass
http://www.rcgp.org.uk/membership/membership-grades/join-rcgp-trainee-gps.aspx.
There are three components to this integrated assessment programme, as detailed below:
Applied Knowledge Test (AKT) http://www.rcgp.org.uk/training-exams/mrcgp-
exams-overview/mrcgp-applied-knowledge-test-akt.aspx
A three-hour 200 item multiple choice questionnaire, completed electronically at
testing centres run by an organisation called Pearson Vue (www.pearsonvue.co.uk/). Questions are mostly clinical, with additional
components on interpretation of evidence and on organisational issues.
Occurs three times a year and GP Trainee books their test via the RCGP website. Some of the information in the AKT is based on practice management and
administration and the practice manager can be very helpful in preparation. The
relevant section of the guidance is “Administration, ethical and regulatory
frameworks”. The Practice Manager will have a vital role in teaching the registrar
about appropriate organisational processes. You might also encourage the
registrar to attend business and partnership meetings. If a GP Trainee fails the test they will be able to re-sit it. Four attempts are the
maximum allowed.
Study leave is to be taken for the attendance at the test centre and also any
appropriate courses to help the trainee pass the test. As there are 150 centres
across the UK travel time to and from the centre should be relatively short. If a
Registrar should fail the AKT or another test they are allowed extra study leave (Exam leave) which they have to apply for in the same way as all other leave, via
the Intrepid Web Site.
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Clinical Skills Assessment (CSA) http://www.rcgp.org.uk/training-exams/mrcgp-
exams-overview/mrcgp-clinical-skills-assessment-csa.aspx
This is defined by the RCGP as being “an assessment of a doctor’s ability to integrate and apply clinical, professional, communication and practical skills for appropriate
general practice”.
Available three times a year and they are based in Croydon.
Each candidate has 13 ten minute appointments with “patients” (actors who are
playing the part of patients), and their performance is graded as clear pass,
marginal pass, marginal fail or clear fail. The assessment lasts for half a day.
Attendance for courses to help pass the CSA and the actual day of the assessment are to be taken as study leave. Travel to and from the assessment
centre should be achievable on the same day.
Trainees in the east midlands are offered quite a bit of support towards Workplace-based Assessment http://www.rcgp.org.uk/training-exams/mrcgp-
workplace-based-assessment-wpba.aspx
This is defined by the RCGP as “the evaluation of a doctor’s progress in their
performance over time, in those areas of professional practice best tested in the
workplace”.
The WPBA is expected to:
Provide feedback on areas of strength and development needs.
Identify GP Trainees with difficulties.
Drive learning in important areas of competence.
Determine fitness to progress to the next stage in the GP Trainee’s career.
Evidence in the above areas of competence is collected over all three years of training and recorded in the GP Trainee’s ePortfolio. The tools that are used to collect evidence
are as follows:
Case-based discussion (CBD)
Consultation observation tool (in primary care only) (COT)
Multi-source feedback (MSF)
Patient satisfaction questionnaire (PSQ)(in primary care only)
Direct observation of procedural skills (DOPs)
Clinical examination and procedural skills (CEPS)
Clinical evaluation exercise (Mini-CEX) (in hospital posts)
Clinical supervisors report Educational supervisors report.
The use of these tools during training does not involve pass or fail assessments, but
rather judges on whether there is enough evidence or whether there is a need for further
training. At regular points throughout training the evidence is reviewed and a qualitative
judgement about progress through each area of training is made, until competence is
demonstrated. WBPA is, therefore, a developmental process and is used to provide
feedback to the GP trainee and drive their learning. The progress of a trainee is
evaluated at what is known as a “panel”, where an outcome of the assessment is
awarded. http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-
wpba/arcp-for-workplace-based-assessment.aspx As a Practice Manager your role might be to provide clear feedback in the MSF about the
trainee. You might need to let the admin team members know about consent forms and processes for obtaining recorded surgeries for COT assessments. You might also need to
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ensure secretarial staff understand how to log on PSQ results. You might also wish to
consider how you inform patients that you are now a training practice and that assessments might be occurring.
ePortfolio
When the GP Trainee registers with the RCGP at the start of their training they will be
given access to the ePortfolio which will be used through their three years of training. It
is a record of learning, which will hold details of the GP Trainee’s achievements in the
AKT and CSA, as well as document evidence of WPBA.
The ePortfolio belongs to the GP Trainee, but parts of it are accessible to the trainer,
educational supervisor and administrators through a permissions system. It also contains links to learning resources, and is to be used by the GP Trainee in order to obtain their
certificate of completed training from the GMC.
It is crucial that the training programme is given the name of the trainer who is
responsible for the trainee in a practice and that the supervisor name is on the e-
portfolio.
Reviews of progress
The GP Trainee’s Educational Supervisor will make annual reviews of the progress of GP
Trainees, using evidence from e-portfolio and any other relevant source. During this
review, the educational supervisor will decide whether the GP Trainee is making
satisfactory progress or whether they need to be referred to panel. Discuss any
concerns you have with the GP trainer in your practice at an early stage. Educational and clinical supervision
An educational supervisor is at GP trainer who has overall responsibility for oversight of
a trainee’s educational development for the duration of their training programme. They
will help to guide the trainee to achieve the competences required and will perform assessments on the evidence in the ePortfolio usually 6 monthly They usually meet with
all their educational supervisees at least twice a year in June and January (for trainees
on a normal 3 year programme). Educational supervisors receive an extra fee for
providing this service for the first two years. This supervisor will usually be the trainer that hosts the trainee for their final period in
GP at the end of their programme. A trainer may be educational supervisor for more
than 1 educational supervisee at any one time. They have overall responsibility for
reporting to the LETB about the progress of the registrars, whether they are attached to
the practice or not. A clinical supervisor is a clinician (hospital consultant or a GP) who oversees a trainee
during a specific post. They will provide day-to-day advice on clinical matters,
educational matters and also assessments during that post, with a report at the end of
the post.
Once a GPST is allocated to a practice, the practice should receive details of the
allocation, who the trainer is and various information about the trainee, including a K4
form (which has a lot of information and can be found at Appendix 1) and salary
information. If this information is not sent you should contact the Locality Programme. There is also a sample New Employee Checklist (Appendix 2) for the practice – it is vital
that some pre-employment checks are made by the practice manager. Remember that a
trainee cannot see patients without:
Membership of the performer’s list
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Medical indemnity
Being on the GMC register (without conditions)
The correct visa (if appropriate)
Normally there are some checks before the trainee arrives, but to avoid any risk to the
practice, certificates for these areas should be seen before any patient contact is
allowed. Verbal reassurance is not sufficient. INDUCTION
An induction process is important for all employees new to the Practice, and GP Trainees
are no exception to this. It ensures a positive welcome to a new recruit and will help
them to settle and integrate into the Practice more quickly.
NB In an ideal world GP Trainers would be able avoid taking annual leave during the first
two weeks of a new GP Trainee’s time at the Practice, to ensure they lead the induction
period and process, and get to know their new Trainee. It would be helpful if Practice
Managers could also follow this guidance. However, since the starting and changeover
dates are the first Wednesdays in August, December and April, it may be impossible to
follow this ideal. With preparation and communication before the start date, difficulties
can be avoided. Induction
It is ideal if the Practice Manager contacts the Trainee in advance of their
starting. A sample introductory email can be found at Appendix 3. A Trainee can
visit the practice a few weeks in advance of the start of the placement, to show
them round, get to know them and to give them a small amount of preparatory
work to do before day one. It is normal for the Practice Manager to be involved in
this meeting – you may be able to help the GP Trainee jump any bureaucratic hurdles in advance of them starting at the practice.
Induction length varies but an optimum length of time is suggested to be two to
four weeks. During this period the new GP Trainee should be introduced to
members of the Practice team, both employed and attached (e.g. the District
Nurses and Health Visitors) have the opportunity to meet and observe/shadow
clinicians and non-clinicians, learn about the Practice’s computer system, and
receive general orientation into their new environment and surroundings. An
example of an induction programme is included in Appendix 4 at the end of this
document and an example induction timetable in Appendix 11. Health and safety information is crucial during this process.
Some practices use questionnaires to send out to GP Trainees new to their practice, to
establish what knowledge they already possess. These are then used to shape both the
induction plan and the educational plan.
Induction Pack
As it is often difficult for a new recruit to remember all of the information they receive
during induction, training practices should have and maintain an induction pack, which
can be updated prior to each new GP Trainee starting at the Practice (this may also be a
more generic document that is given to other new employees, or contractors such as GP
Locums). This can be kept in a variety of formats: in hard copy or on a shared drive on
the computer, or the Practice Intranet if one is available. The content of an induction pack might include the following and a sample document can
be found at Appendix 4:
The Practice Team – a brief résumé of who’s who and what they do, broken down
by Doctor, Practice Nurse and Support Staff. This is especially useful if clinicians
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have a special interest in a particular area, or run a certain type of clinic, for
example. It will also help a new GP Trainee to know who to approach in respect of the different administrative functions that they are likely to be exposed to.
Computer system – information about the Practice clinical computer system, data
entry, and where shared drives/intranet/etc can be found, and how they’re used.
It is also useful to have handy hints and tips, and where trouble-shooting help
can be found. Templates etc.
Seeing patients – the appointments system, details of how on-call works and
arrangements for home visiting. Details of the various clinics, the days they take
place and who runs them is also useful, as well as how Practice Nurses, Health
Care Assistants and Phlebotomists, and attached staff are accessed.
Prescribing – details of the Practice formulary should be included, as well as how
repeat prescriptions are managed, and protocols and procedures relating to
medicines management.
Other useful information – it is beneficial to have a section on other matters that
are pertinent to your Practice. This should include specific protocols that you wish
to draw attention to, pathways for chronic disease management, how diagnostic results are handled, or the fact that the Practice looks after certain
Nursing/Residential Homes in the area, for example. Useful telephone numbers – a list of staff and attached staff (names and job
titles) with their contact details should be included, as well as other useful telephone numbers (eg, local hospital, CCG and LAT , pharmacies, police,
patient transport/ambulance, undertakers, etc). All these can be accessed via
most Intranets.
Access to the Practice premises and car parking – details of what times the GP
Trainee can gain access to the surgery building should be included, particularly if
a staff entrance should be used for times when the public do not have access. It
is also useful to know how to access the building out of hours, should they need to. Car parking can often cause difficulties, as many surgery buildings have
limited car parking available, so arrangements should be made clear to the GP
Trainee.
Maps – detailed maps of the Practice area are invaluable in helping the new GP
Trainee find their way around.
CONTRACT OF EMPLOYMENT http://bma.org.uk/news-views
analysis/news/2014/april/revamp-for-gp-trainee-contract
When a GP Trainee is on rotation in General Practice, they are employed by that
Practice. They have the same employment rights as any other Practice employee, and as
such should have a written Statement of Particulars of Employment as part of a Contract
of Employment within two months of starting at the Practice. Note though that some
rights may be better than employees of the Practice, eg. Sick leave (there is NHS
contractual sick leave that SBS will need to determine)
It is suggested that the new GP Trainee should be given their contract on their first day
at the Practice, and that time is set aside during their induction period to go through the
contract in detail, answer any questions they may have and ensure that it is signed by
all parties. The BMA model contract is available on their website (see link above). The
March 2014 revision can be found at Appendix 5.
It is worthwhile drawing particular attention to the following headings within the
contract: Terms and Conditions of Service
It is be a condition of service that the GP Trainee is on the local Performer’s List, as GPC
guidance states that medical practitioners may not perform primary medical services
unless their name is included in the medical performer’s list. In the case of GP Trainees,
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they are registered with limited registration until such time as they qualify as a GP. In order to be placed on the performer’s list, an application must be made to the Local
Area Team, which includes proof of their qualifications and registration number and
details of their GP Trainer.
Any trainee who does not provide the required documentation for starting a new post
within 2 weeks should be discussed with the training programme. Salary and Allowances
GP Trainees are entitled to receive a mileage allowance as part of their employment. Further information regarding this is included in the finance section of this manual. Normally the payment that the Registrar will receive will be determined by SBS who will
send through a notice of salary and pension contribution, usually by the 15th of the month. If you have not received that information phone Denise Menzies at SBS 01332
868978. Pension Contributions
You do not need to deduct the Pension Contribution from the reimbursement paid to you
each month because SBS have already done that. However, you do need to show it on
the GP Registrar payslip when you tangibly pay him or her. The GP Registrars payslip
should match the salary data on their remittance advice, which necessitates two
different Pension deductions from two different payments. One from the payment that
SBS make to you pertaining to the GP Registrar and one from the funds that whichever
payroll system/company you use who tangibly pays into the GP Registrar's bank
account. When the GP Registrar finishes his or her tenure at your Practice their Pension
Contributions are paid over to The Pensions Agency the Pensions Team at SBS. See
Finance Section for further information. Professional Registration and Indemnity
GP Trainees are required to have, and maintain, full GMC registration. They are also
required to have, and maintain membership of a recognised medical defence
organisation, approved by their Trainer. GP Trainees on integrated posts should be
reminded that they need to advise their defence organisation of this, as it may affect the
tariff. The cost of defence membership is reimbursed, as outlined in the section on
finance and Appendix 8. The Practice must check the relevant documentation
when the GP Trainee starts work at the Practice, and ensure that the GP
Trainee produces evidence of renewal, if that falls during their rotation at the
Practice. Please find checklist attached as Appendix 2.
Transport All trainees must provide transport which enables them to undertake home visits and to
be on call. If they do not have a car, they must provide transport that will enable them
to do this. Public transport or taxis are not acceptable for being on call. Trainees who do
not have a driving licence sign a statement at recruitment saying that they will provide
suitable transport. Cars should be insured for business use. Annual Leave
The amount of annual leave for GP Trainees is 6 weeks plus Bank Holidays. This is pro
rota according the length of their rotation and can be confirmed with the LETB.
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Maternity Leave As employees of the practice, a GP Trainee has the same statutory rights as any other
employee, which under current legislation is 52 weeks. What is important for GP
practices is to ensure that the GP Trainee satisfies the provisions set out in the Strategic
Health Authorities and GP Registrar (Amendment) (No 2) Directions 2007 to continue
being reimbursed the cost of the allowance paid to the GP Trainee.
The Trainer can continue to be reimbursed the cost of the allowance paid to the GP
Trainee as long as the following conditions are met:
The GP Trainee has completed 12 months continuous service immediately before
the beginning of the eleventh week before the expected week of confinement
(breaks of less than three months are disregarded) – continuous employment by the NHS is the factor used in determining this.
The GP Trainee continues to be employed by the Trainer until immediately before
the beginning of the 15th week before the expected week of confinement
The GP Trainee notifies the Trainer, in writing, of her intention to take maternity
leave and whether or not she intends to resume training with the same or
another Trainer after her confinement. This must be made no later than 21 days
before the start of maternity leave. That the GP Trainee gives the Trainer a MATB1 no later than 21 days before
starting maternity leave. The payments made to GP Trainers in respect of the allowance for GP Trainees during
maternity leave are as follows:
First 8 weeks – full allowance less any SMP or maternity allowance Weeks 9 to 26 – half of the full allowance, providing the total receivable including
SMP or maternity allowance does not exceed the full allowance
The GP Trainee is entitled to 52 weeks leave.
Additional Leave
If the GP Trainee needs to take more than an additional two weeks off in any one year
(beyond statutory annual leave; for example, for sick leave, compassionate leave, or
unpaid leave) this may need to be added onto their training at a later date, to ensure
that they complete the statutory period required for training. All leave, other than annual leave, must be notified to the GP Training Programme who
will keep a record for total additional leave taken in any one year (see Appendix 9).
Registrars will apply and an email will be received by the GP Trainer and the Practice
Manager in order that approval can be given.
Less than full time working (less than full time - LTFT) The Department of Trade and Industry’s (DTI) Part-time Workers (Prevention of Less
Favourable Treatment) Regulations came into force on 1st July 2000. These regulations
make it unlawful for employers to treat LTFT workers less favourably than full time
workers. The BMA has, therefore, issued guidance for GP Trainees working LTFT, to
ensure that the GP Trainees and Trainers are aware of the entitlements under this directive, and how to make the best use of associated work and training arrangements.
The theme that runs through the BMA guidelines on flexible working is equity. The
criteria for appointment to posts are equal, regardless of whether a GP Trainee wishes to
work full or part-time, and a GP Trainee does not need to make known the fact that they
wish to work flexibly until after an appointment has been made. If a Trainee does decide
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to work less than full time the Practice Manager will need to ensure that the payments
for salary and pension have been adjusted to reflect the part time working.
Timetable All trainees should be provided with a timetable. The normal working week comprises 10
sessions amounting to 40 hours. Of these, 7 should be clinical, one for the half day
release, 1 for planned practice educational events and 1 for self-directed learning. The
European Working Time Regulations apply to GP trainees. Since they also have to do
some out of hours training, it is important to monitor the amount of work commitment
and breaks they have to ensure there is no contravention of the rules.
http://www.wessexdeanery.nhs.uk/guidance__recourses/guidelines__procedures/ewtr.as
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As part of the timetable, agreed periods of protected time debrief should be included. For
the debrief, the trainer or one of the other doctors in the practice should spend time
reviewing the patients with the trainee to ensure there are no learning points for the
trainee, or safety issues from a patient’s point of view. The LTFT GP Trainee’s timetable in the practice should be agreed in advance of their
starting by the LETB, in particular the number of sessions to be worked each week, and
the duration of their training. Once set, the timetable should be fixed, although some
flexibility should be negotiated to ensure that the full range of experience is gained (e.g.
baby clinics, practice meetings, minor surgery etc.).
If, for example, a GP Trainee opts to work at 50%, the hours should be a true 50% of what a full-time GP Trainee would work. A sample timetable can be found in Appendix 6.
Independent Study
A full time GP Trainee will usually have a half day per week for private study in addition
to half day release. LTFT GP Trainee should have the same amount of time built in pro
rata although it can be negotiated by the trainee when applying for LTFT at the LETB
Tutorials
Study Leave
All trainees are able to take study leave as well as their holiday leave. Practice managers
are asked to confirm that leave for the trainee is approved as part of the process. This
will be sought by email at least 6 weeks in advance of the required leave.
GP TRAINEE WORK PLAN When starting, a GPST will require quite a lot of support and should be made aware how
to access advice at any time. Their appointment length should at all times be by negotiation, but initially is likely to be 20 or even 30 minutes. Partly this will be to get
used to the IT. However, pretty quickly, most trainees can reduce their appointment
lengths so by the end of training, this will fall to the same as that of the other doctors in
the practice.
The actual work plan should be tailored to the individual, and be flexible enough to
ensure that they develop at a rate appropriate to them and their learning.
The trainer and or practice manager would ideally have a session where the workload is discussed. During this session, a work plan should be put together that details:
Hours of work – when they need to make themselves available to work at the surgery,
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and surgery times
Numbers of patients to be seen – this will be defined by the length of appointments, which may be as long as 30 minutes per patient to begin with, but with the aim of
moving to 10 minute appointments by the end of training.
Home Visiting – the stage at which they will undertake home visits, which may be
accompanied by the Trainer to begin with, and what number will be allotted to the
trainee at different periods of the training programme.
On call – at what stage, and to what extent, they should participate in on call activities
By its very nature, the work plan needs to be flexible and responsive to the need and
ability of the individual GP Trainee. The Trainer will need to make an objective
assessment of the GP Trainee in order to assess whether they are able to move on in
their training, and they have a number of tools that they can use in this process: Observing the GP Trainee – at the start of the six month rotation there is likely to be a
significant amount of this type of assessment. This will be done either by the Trainer
sitting in on the GP Trainee’s consultations or by the GP Trainee and the Trainer carrying
out joint consultations. Recording consultations –are an important part of training. This is an invaluable tool for
the GP Trainee and Trainer to assess communication, consultation and diagnostic skills
and ability. Multisource feedback – this is a common form of appraisal for all staff, not just GP
Trainees. All members of the practice team, both clinical and non-clinical, will be asked
for feedback about the GP Trainee, and this will then be fed back and discussed with the
GP Trainee. Informal Feedback – all team members are encouraged to give informal feed back to the
Trainer Time for debrief of surgeries and home visits need to be built in to the working day
Tutorials – Improved and increased knowledge demonstrated by the GP Trainee during
tutorials is also a means for the Trainer to assess progress - 3 hours of protected
teaching time needs to be provided per week (pro rata for LTFT trainee’s).
All the above tools will give an impression of the GP Trainee’s competency, and will be
used to make decisions about the GP Trainee’s work plan. The Trainer will need to
ensure that they keep evidence of all the assessments they have made. GP TRAINEE EDUCATIONAL PLAN
Formulation of the educational plan will usually be carried out during the induction period
and needs to be tailored to the individual (see section relating to this in Appendix 5). As
per the work plan, it needs to be flexible and responsive to the educational needs of the
GP Trainee. The GP Trainee will devise and discuss their study requirements with their
Trainer and educational supervisor, and this will be reviewed regularly.
It is likely that there will be a significant amount of overlap between the educational plan
and the work plan, especially in the first six months, particularly as assessment of
learning and progress is made as per the process outlined above under work planning.
Tutorials
The Trainer will discuss the topics that need to be covered by tutorials during induction,
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and as time goes by, but this will be reviewed and amended as necessary on a regular
basis. Whilst the Trainer will deliver some of the tutorials, other members of the clinical and non-clinical team will also participate in and deliver tutorials.
Practice Manager input to tutorials is important, and this will be covered in the
section below.
GP Locality Training Programme half day release
Study leave granted as per the GP Trainee’s contract of employment includes attendance
at GPTP. Because the half day GPTP seminars are given as paid study leave, GP Trainees
are expected to attend them regularly, and explain their reasons for any non-attendance
to the GPTP Course Organiser. If absence is unexplained, this will be reported to the
Trainer, and it may be counted as half a day’s annual leave. Frequent non-attendance
will lead to discussion about continuation on the GPTP. LTFT trainees will have had it made clear what their attendance rate is expected when
their LTFT is agreed. Independent study
As full time GP Trainees are contracted to work 10 sessions per week, this one session
per week is not counted as a half day. Its purpose is to allow the GP Trainee time to:
Prepare for tutorials.
Carry out audit or project work.
Study for and take exams.
Prepare for GPTP afternoons.
E-Portfolio.
GP Trainees are expected to keep a record of how they use this time.
Approaches to learning
There are two main methods of learning during the GPTP – learner centeredness (or
active learning) versus teacher centred training (or passive learning).
Learner centeredness places the GP Trainee, or learner, at the centre of the learning
process where they are the active person in their own learning. The learner learns at
their own pace, using their own strategies and is more individualised than standardised.
This approach uses techniques such as problem solving and reflective thinking, and
adapts to different learning styles so that the learner can use the method that suits them
best. This is also known as Active Learning, with the student using their own experience and
study to learn. This means that a skill or knowledge is developed by practice, and by
actively trying something. This is in contrast to teacher centred learning, where knowledge is passed from the
expert (teacher) to a student (GP Trainee). This is also known as passive learning, and is
believed to be less effective than active learning, because it is said to encourage surface
learning, with students not necessarily gaining the insight they need. The greater emphasis in GPTP is on learner centeredness or active learning, with GP
Trainees gaining the skills they require to qualify and become a GP by on the job
experience, reflection and problem solving. This is not to say that passive learning does
not play its part during GPTP as GP Trainees need to gain necessary and relevant
information by attending lectures and tutorials, watching videos and reading.
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PRACTICE MANAGER INPUT INTO TRAINING
The Practice Manager is well placed to provide information about the business side of GP. Whilst trainees are led by their curriculum as to what is required for their ePf (see below), preparation for independent practice requires them to know about the following:-
Topics can include:
“What is a Practice Manager?”
Personnel/HR management (eg, staff roles, employment law)
GMS/PMS, including QOF, Enhanced Services, etc
IT
Finance, including an explanation of accounts
Commissioning
Customer service (e.g. access, complaints, patient information)
Premises
The NHS organisation and the political dimension of the NHS
Presentational skills
Time management
Effective meetings
Verbal and written communication skills
Professionalism in partnership
Looking for a partnership (eg interview skills, interpreting accounts, partnership
agreements)
Team working
Change management
Audit
Information governance
Significant event audit
There is lots of information available on all these subjects on the internet.
Implications of the MRCGP The MRCGP curriculum http://www.rcgp.org.uk/training-exams/gp-curriculum-
overview.aspx has a section on Management in Primary Care, which has the following
learning objectives:
Primary care management
Ability to co-ordinate care with other professionals in primary care, and other
specialists
Master effective and appropriate care provision and health service utilisation
Act as an advocate for the patient
Patient Care
Demonstrate understanding of the expectations that patients, carers and families
have of their practice and local primary care services
Demonstrate understanding of how to involve patients in the management of the
practice and local primary care services
Specific problem solving skills
Rights and duties as an employer
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Key features of GP contractual arrangements
General Practice organisation, and its variation according to setting
Financial aspects of practice (sources of income, expenditure, managing funding,
use of premises, marketing, interpreting accounts)
A comprehensive approach
Demonstrate understanding of the culture of administrative organisations, and
contribute to debates on the management of local health services
Demonstrate understanding of the ways in which healthcare may be appropriately delivered in the community
Community orientation
Demonstrate an understanding of the make-up of the community they are
working in (eg socio-economic, ethnic and health features)
A holistic approach
Demonstrate understanding of the positive benefits of involving patients in their
care and in the systems of health care provision and quality improvement
Contextual aspects
Demonstrate awareness and understanding of the impact of the local community
on the workplace and patient care
Demonstrate awareness and understanding of the impact of how the health
service is organised locally and nationally, and how any variation in resources and
facilities may affect healthcare delivery
Demonstrate awareness and understanding of important local and national
strategies for the development of healthcare. Attitudinal aspects
Demonstrate awareness of their own capabilities and values
Can identify ethical aspects relating to management and leadership in primary health care
Awareness that own attitudes and feelings are important determinants of management and leadership
Scientific aspects
Demonstrating an understanding of the key national guidelines influencing
healthcare provision locally and nationally The MRCGP curriculum documentation suggests a number of ways that the above
learning can take place, which use both active and passive learning approaches:
Work-based learning in primary care:
Attending practice meetings
Tutorials on finance and administration
Visiting different Primary Care Organisations (eg, GMS/PMS practices, out of
hours and walk-in centres)
Involvement in selection, recruitment and appraisal of staff
A project to improve practice’s services to patients
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Non-work-based learning
Formal tutorials on NHS structures, policies and strategic direction
Sessions on team dynamics, recruitment, selection, equal opportunities,
motivation and leadership Learning with other health professionals
One-to-one sessions with different members of the primary care team
Using existing opportunities to research, discuss, evaluate and implement change
across a wide range of professions from health and social care settings
There is clearly a significant amount of learning involved in the above description, and
the majority of Practice Managers would find it difficult to input more than a handful of
tutorials, plus informal and ad hoc training for the following reasons:
Time – the number and complexity of the above requirements are likely to
require time that a Practice Manager does not necessarily have
Knowledge base – whilst many Practice Managers have a broad understanding
and knowledge base of the wider NHS agenda, plus local socio-economic and
demographic factors, it is a complex issue, and one that changes regularly, making it challenging for Practice Managers to stay up to date
Practice Managers have many and differing strengths. Whilst some are
comfortable taking on additional teaching and training, some may be less willing
to do so, preferring to concentrate on the “day job”.
Taking a different approach – whilst practices may already use some of the
learning approaches detailed above, the MRCGP also suggests some different
approaches to learning. Included in this is the suggestion that GP Trainees are involved in recruitment, selection and appraisal of staff. How practices would
actively manage this, including the associated implications and responsibilities,
would need to be carefully thought through.
Some possible suggestions for how at least some of the objectives could be delivered are
as follows:
A carefully thought out and targeted project could be used to meet a number of
learning objectives
Increased use of Practice Managers to teach formal tutorials during GPTP
seminars on some of the above subject areas
Sharing tutorials with neighbouring training practices TRAINEES and FINANCE
The Practice will receive reimbursement for the following:
Salary for each GP Trainee
Employee’s superannuation contribution
National insurance contribution
Reimbursement of motor vehicle mileage/Regular User Allowance
Training grant
Defence subscription Other reimbursements that are paid if they are incurred are:
Childcare vouchers
Maternity pay
Sick pay
Removal expenses
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Payments are made to the Practice on a monthly basis by SBS and the remittance advice
will detail the payments made.
The following paperwork needs to be completed when the GP Trainee commences
employment at the Practice:
1. Personal Details Form
These are usually forwarded to the Practice automatically by the LAT, but can be
obtained from the Finance Department of the LAT if one is not received. This needs to be
completed by the GP Trainee and by the Trainer.
The section to be completed by the GP Trainee asks for the following information:
Name and date of birth
National insurance number
Where they were last employed, and in what capacity
Last NHS employment date
Date of full GMC registration plus GMC number The section that the Trainer needs to complete asks for the following information:
Name of Trainer
Period the GP Trainee will be at the practice
If the practice will require vehicle allowance for the GP Trainee 2. Claim form for reimbursement of medical defence subscriptions This needs to be completed with the GP Trainee’s name, and date of qualification, and
the total amount payable in Medical Defence subscriptions whilst employed at the
practice. The basic subscription that would have been payable if the GP Trainee was
employed in a hospital during the same period is then deducted, plus any amount that has been paid by the practice to the GP Trainee. The GP Trainee must sign the form.
A copy of the Medical Defence Certificate needs to be attached to the form before
submission to the LAT
3. Notice of inclusion/exclusion of the motor vehicle allowance for national insurance
contribution purposes
The car allowance that a GP Trainee receives may attract a liability for national insurance contributions if the total amount of motoring expenses received exceeds a statutory
maximum. Only amounts up to the statutory maximum can be paid free of NIC. The GP
Trainee will, therefore, need to advise you of whether they need to pay NIC on the
whole, part or none of the car allowance, and the relevant box on the form ticked. If part
of the car allowance attracts liability, they will need to advise you of the amount, and
this will be included on the form. Further guidance can be found at
www.hmrc.gov.uk/guidance/ca33.pdf 4. SD502
This form needs to be completed and submitted to the LAT if the GP Trainee is not going
to participate in the NHS pension scheme. GP Trainee Salary
The allowance, or salary, paid to a GP Trainee is detailed in HEE and GP Trainee
Directions, which can be obtained from websites such as the Department of Health or the
British Medical Association. www.dh.gov.uk and www.bma.org.uk
When a GP Trainee commences employment with the Practice, the local LAT will confirm
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their salary, which is split between a basic and supplementary element. The basic
element, which is also known as the GP Trainee basic allowance, is a hospital salary
taken from the last NHS appointment held. Added to this is an additional amount, known
as the GP Trainee supplement. The two figures are added together to make up the total
salary of the GP Trainee. SBS will issue a notice of the salary and pension deduction – it
is best to use their figures. Only the basic element, or allowance, is superannuable, the
supplementary element is not superannuable. If the Practice uses electronic payroll, some payroll systems such as Iris, have a specific
screen to enter data for GP Trainee salaries and allowances, which make the correct
calculation of their salary simpler. Check with your own system supplier whether this
facility is available on your electronic payroll system. When making monthly submissions and payments to the NHS Pension Scheme, ensure
that the Practice does not make a payment to the Pensions agency on the GP Trainee’s
behalf, as SBS does this. This is of particular note for a practice that uses an electronic
payroll system which automatically generates the LP11-GP form – check that the GP
Trainees are not included, and deduct them manually if they do appear on the form.
With a package such as Iris, where the GP Trainee screen is used, their details will not appear on the LP11 –
Vehicle Allowance
The arrangements for payment of vehicle allowance have become more complex since
August 2007, and the entitlement to allowance and the associated payments are detailed
in HEEs and GP Registrar (Amendment) (No 2) Directions 2007.
All mileage claim forms need to be countersigned by the practice (see Appendix 10). It is
their responsibility to ensure that claims are correct. There have been instances of trainees making incorrect claims which have been countersigned by practices.
Summary Check List
In summary, the following is a check list of forms and certificates that will be required
when a GP Trainee commences employment at the Practice:
Personal details form – to be completed and signed by the GP Trainee,
countersigned by the Trainer and returned to the LAT
Claim form for reimbursement of Medical Defence subscription – to be completed by the GP Trainee, countersigned by the Trainer and returned to the LAT with a
copy of the medical defence certificate
Notice of inclusion/exclusion of the motor vehicle allowance for national insurance
contribution purposes
SD502 – if not participating in the NHS Pension Scheme – to be completed and
returned to the LAT
The practice must require the following:
Copy of Medical Defence certificate (for own and LAT records) Copy of GMC Certificate
P45 from previous employment (or P46 if they do not have a P45) Confirmation of inclusion in the LAT’s Performer’s List
DBS Clearance
Bank/building society details, if paying salaries by BACS Any relevant work permit or visa
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Trainees cannot see patients independently unless there is evidence of GMC
registration, medical defence cover and they are included on the performer’s
list.
PRACTICE POLICIES GP Trainee’s Handbook
The majority of practices will have a Staff Handbook, and this should contain all
important practice policies – these will include both the practice’s statutory obligations as
an employer, as well as policies specific to the practice. As with any new employee, the
GP Trainee should be advised where they can locate a copy of the handbook when they
commence employment at the practice. In addition to this, the BMA recommend that a training practice should have a specific
hand book for GP Trainees in General Practice. A specimen handbook can be found on
the BMA’s website (www.bma.org.uk) as Appendix 5 of the specimen contract “GP
Trainee Handbook”. Complaints
A section on this should be included in the practice’s GP Trainees Handbook, but a
specific mention of it here is worthwhile. Whilst the relevant section in the handbook
should detail the process for handling complaints, it is important to manage this process
in a sensitive and careful way not just for the patient, but for the GP Trainee as well. It is important that due procedure is followed to the letter when dealing with complaints,
and that the GP Trainee is supported during the process. For the vast majority of GP
Trainees, any complaints they receive during the GPTP will be their first, and will be
likely to affect their confidence. Depending upon the nature of the complaint, as employees of the Practice, this may also mean that they are taken through the Practice’s
disciplinary procedure, and so the GP Trainee will also need to be made aware of this.
One matter of note is that the Trainer could be held responsible for the actions of the GP
Trainee if it is felt that they have exposed the GP Trainee to the particular situation that
has led to a complaint, before they are ready. This is one of the many reasons why
documentation, both on the patient record and in respect of assessment of the GP
Trainee’s progress, is important. This will help to determine where responsibility lies.
If a complaint is received about the care a GP Trainee has given a patient, or their
conduct, once they have left the Practice, the Practice’s complaints procedure should still
be followed. The GP Trainee will need to be contacted at their new place of work, and
appropriate arrangements made to pursue and conclude the complaint.
The GP Trainee and the Practice should contact their medical defence organisations for advice where necessary.
Critical Incidents
As with complaints, any critical incidents that arise during the GP Trainee’s rotation in
the Practice should be managed in a sensitive manner, using the appropriate practice
procedure. If something goes wrong, it is important the GP Trainee learns from the situation
accordingly to try and prevent a reoccurrence. Appropriate support should be given to
the GP Trainee to ensure that they do not lose confidence. Also as with complaints, if it
is felt that the Trainer has exposed the GP Trainee to a particular situation before they are ready, then they will need to bear appropriate responsibility for the outcome,
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especially if the incident is of a serious nature. Once again, documentation, both from
the patient record and evidence of assessment, will be vital in this situation. Complaints and critical incidents should be recorded by a trainee in their ePortfolio
INFORMATION MANAGEMENT AND TECHNOLOGY
In the modern world of General Practice, patient information is driven by the electronic
patient record. As a result, the way in which data is entered onto the computer is very
important, and there are two main reasons for this:
Patient Care The GP Trainee will need to learn how to use relevant read codes for diagnosis and care.
Most practice computer systems will be set up with templates, or guidelines, that will
assist in this process, as well as a means of creating priorities for the information that is
added.
Equally as important is the way that free text is used. This should be concise, detail the
reason why the patient has visited the GP Trainee, and what the GP Trainee has advised
the patient (for example, a diagnosis/likely or differential diagnosis, and if the patient
has been told to return for diagnostic tests and what those tests are).
Because the GP Trainee will only be at the practice for six months, this means that other
clinicians will be able to see what care has been given to the patient. In respect of
complaints or potential litigation, this is also very important. Management Information
In respect of management, probably the most important reason that data needs to be
entered in a consistent and accurate fashion is for the Quality and Outcomes Framework
and Enhanced Services payments. If an incorrect code is used, the audit function of the
practice computer system and/or QMAS will not pick the data up, and the practice could ultimately lose out financially.
Initial computer training for the GP Trainee will be carried out during their period of
induction, but ongoing training should be given as required during their rotation at the
Practice for the reasons as outlined above. As detailed in the induction section of the
manual, it will be useful to give the GP Trainee a list of codes and priorities for common
conditions for easy reference, as well as hints and tips on trouble shooting.
Non-clinical system computer use The majority of practices will be as paper-light as possible. This means it is likely that
there will be a separate drive on the main computer server for storing such as word and
excel documents, and information from the internet, for example. The person
responsible for IT and IT training should spend time with the GP Trainee to ensure they
know how and where to save documents.
It should also be made clear to the GP Trainee to what extent they may use the practice
computer system for private or personal use.
Careful induction into the use of the computer system and all the above aspects is
advised. This is usually handled by the Practice Manager, or a member of administrative
staff who has responsibility for the computer system.
Use of internet and email
The GP Trainee’s attention should be drawn to the practice’s policy for use of the internet
and email, to ensure that it is used appropriately, and that the practice is not exposed to
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problems such as computer viruses, or inappropriate computer use.
Data Protection All practices must be registered under the Data Protection Act 1998. Practices who have
signed up to the IM&T Directed Enhanced Service will need to have a nominated and
trained Caldicott Guardian as part of the requirements for component one. However,
even if the practice is not participating in the IM&T DES, there should still be adherence
to the principles of Caldicott guardianship and associated information governance. Caldicott Guardian
The Caldicott Guardian Manual lists 6 key principles taken from the original Caldicott
report, as follows:
Justify the purpose(s) for using confidential information
Only use when absolutely necessary
Use the minimum data that is required
Access should be on a strict need-to-know basis
Everyone must understand their responsibilities
Understand and comply with the law
If the GP Trainee is not aware of these principles, they should be made aware of them,
as they go beyond the basic principles of patient confidentiality towards the way that
information is used.
Clearly trainees need to be aware of the issues of using memory sticks or patient records
when taking them away from the practice for consultation work or case discussions. Smartcards
In order to access NHS National Programme for Information Technology (NPfIT)
systems, for example Choose and Book, a smartcard is required. If the GP Trainee does not already have a smartcard, one will be required. The local LAT will be able to advise
where and how smartcards can be obtained if the Practice does not already know.
When the GP Trainee leaves the practice they can take the smartcard with them, but it
will need to be deactivated from use on the Practice’s IT system. Again, the local
smartcard officer will make the appropriate arrangements.
PRACTICE ORGANISATION
Consulting Rooms
Where possible, the GP Trainee’s consulting room should be located as close to the
Trainer as possible, as this will make communication and support for the GP Trainee
easier. If a practice has more than one GP Trainee, and therefore by implication more
than one Trainer, it is advisable to organise the GP Trainees’ and Trainers’ consulting
rooms into one area of the practice. This means that if one of the Trainers is away from
the Practice, the other Trainer(s) is on hand to provide support and assistance to both/all
GP Trainees. In a practice with more than one GP Trainee it is advisable to have a practice policy that
prevents all Trainers being on leave at the same time, because it places an onerous
responsibility, particularly in respect of the time commitment, to other partners to
support the GP Trainees in the Trainers’ absence. This can be particularly the case if both
GP Trainees are new to GPTP. In a situation where one of the non-training Partners takes
responsibility for the GP Trainee(s) when the Trainer(s) is away, it is advisable to
relocate either that particular Partner, or the GP Trainee(s), so that they are in physical
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proximity to each other. Each trainee should have their own consulting room. If this is not possible the trainee is
not allowed to use more than 3 different rooms in total. Other doctors are expected to
give the trainee room priority. The reason for this is that trainees have a huge amount of
new information to cope with and trying to locate items in different rooms only adds to
the challenge. Medicines Management
Whilst Medicines Management should form part of the induction, there should also be a
system of regular input during the GP Trainee’s rotation in the Practice, on both a formal
and ad hoc basis. The reason for this is two-fold:
Clinical This is to ensure that the GP Trainee prescribes efficiently, effectively and appropriately.
As many Practices will now hold, or be responsible for, a prescribing budget, the GP
Trainee will need to be made aware of the prescribing schemes the practice is involved
in, and prescribe accordingly. It is likely that the practice’s prescribing lead will have the
main input in this regard.
Practices should have a formulary for common conditions Administrative
There is now a multitude of prescribing functions that are in the main administrative,
and whilst a GP Trainee may not be directly involved, their actions will have an effect,
and their input and advice may be required. Examples of this are repeat prescribing,
repeat dispensing and home oxygen therapy. Practices may have a Medicines Manager
who leads this type of work, and they will need to spend time with the GP Trainee on
both a formal and ad hoc basis to ensure that GP Trainees are aware of the many
prescribing functions and that they adhere to practice procedures accordingly.
Library
As part of the process of the Practice becoming a Training Practice, access to information
should be readily available. Internet access is universally the most important portal for
this. Trainees will usually have already developed their favourite channels for accessing
information before they arrive at the practice. The trainer in the practice may require some written texts that are not available online.
This will usually be texts relating to communication or to aspects of the MRCGP.
Obviously they need to be up to date. Ensure that there is a borrowing policy to retain
copies of books that you have purchased. Access and appointments
The Practice Manager needs to work closely with the Trainer to organise access to the GP
Trainee, and associated appointments. Clearly, a GP Trainee new to GPTP will need
longer appointments, and will see fewer patients than a GP Trainee at the end of their
rotation, or in their final rotation before qualifying as a GP. Access and appointment
arrangements for the GP Trainee will need to be kept relatively flexible in order to
respond to their training needs and associated ability. This has a direct effect on access
and appointments to the Trainer, who needs to have capacity in their surgery time to
give support and review, as required. During the induction period, it is suggested that surgeries with limited appointments are
booked for both the GP Trainee and the Trainer. From this, the Trainer will be able to
review the patients that the GP Trainee has seen, and decide on the starting point for
the number of patients that the GP Trainee can see in a surgery, and the associated
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length of appointment. The Trainer will need to have their surgeries set up accordingly,
with fewer patients, in order to give the GP Trainee support, review the patients that the
GP Trainee has seen and give feedback to the GP Trainee accordingly. When the Trainer is away from the Practice on leave, another doctor will need to take
responsibility for the GP Trainee’s work and have time within their surgeries to provide
the same support that the Trainer does. If the Practice has more than one GP Trainee
and Trainer, it may be appropriate for the Trainer not to have a booked surgery so that
they can provide support to all GP Trainees within the Practice. The need for this will
depend upon the ability of the GP Trainees, and the stage that they are at in their
training. Consent for recording of consultations
Whilst there is not a requirement to submit consultations under MRCGP arrangements, it
is a valuable part of work-place based assessment and the development of consultation
skills. This is because it can be used by the Trainer, along with the GP Trainee, to review
the way in which a GP Trainee consults with patients, to highlight what has been done
well in the consultation and suggest areas for improvement. As part of MRCGP, Trainers
may use a recording doing a COT as part of WPBA Once a decision has been made by the Trainer and GP Trainee that a particular surgery
is going to be recorded the Practice Manager will need to ensure that the Reception team
are made aware of this. It is a good idea to make this decision at least a week prior to
the surgery so that patients can be advised about it when they make the appointment
and verbal consent given prior to the day, if patients are happy to do so. In addition,
display a notice to the effect that the GP Trainee is planning to record their consultations
for that surgery, but that there is no obligation for patients to be recorded if they do not
wish to be. When the patients check in for their appointment, the Receptionist should remind them
that the GP Trainee is recording their consultations that day, and check that the patient
still finds this acceptable. If the patient is happy for the consultation to be recorded, they
will need to complete and sign a consent form, a copy of which can be found at Appendix
7. The patient should then take the consent form with them and hand it to the GP Trainee, which will mean that the GP Trainee knows they are happy to be recorded. At
the end of the consultation, if the patient is still happy for the recording to be used, the
consent form must be signed again. If a decision is made at short notice to record consultations, (for example the day
before, or the day itself), this is likely to mean that patients will only be asked as they
check in for their appointment. Unfortunately, this often results in patients declining
consent because they have the request sprung upon them, and can sometimes mean
that none, or few, of the consultations are recorded. Consent forms should be retained at the practice until the recordings are erased. The
practice should have a system to ensure that recordings are not kept for any longer than
needed. OUT OF HOURS
The new contractual arrangements for GPs that came into place in April 2004 allowed GPs to opt out of direct provision of 24-hour care, and the majority of GPs have done so,
including GP Trainers. The Committee of GP Education Directors (COGPED) responded to
this by producing a Position Statement on Out of Hours (OOH) Training for GP Trainees.
COGPED felt that as the majority of GP Trainers, and their Practices, would not be
participating in OOH work, their Trainees would be put at a disadvantage. Their view was
that the generalist role of the GP should be maintained, and newly accredited GPs would
Page | 27
be expected to have demonstrated their ability to perform competently in OOH primary
care. COGPED defined five generic OOH competencies:
Ability to manage common medical, surgical and psychiatric emergencies in the
OOH setting
Understanding the organisational aspects of NHS OOH care
Ability to make appropriate referrals to hospitals and other professionals in the
OOH setting
Demonstration of communication skills required for OOH care
Individual personal and time management skills GP trainees are therefore expected to do 6 hours per month when they are in GP
placements. They should start as soon as possible with the aim of covering 24 hours in
each of ST1, 2 and 3. It should be noted that GP Trainees should not breach the
European Working Time Directive when taking on out of hours shifts.
The GP Trainee’s clinical supervisor for the OOH shifts will not usually have be their GP
Trainer. The OOH organisations provide clinical supervision – it is the trainer’s role to
assist reflection on the experience reported on their OOH review forms.
PRACTICE MEETINGS AND GP TRAINEE INVOLVEMENT
GP Trainees are expected to attend regular Practice Meetings during their rotation at the
Practice. As Practice Meetings are core to the decision-making and running of the
business, it is important for GP Trainees to understand why such meetings are held and
the way in which formal Practice business is carried out. Prior to the Practice Meeting
GP Trainees should prepare for their attendance at Practice Meetings, to enable them to
get the most out of the experience. One way of doing this would be for the Practice
Manager to give a tutorial on the way that partnerships work, how formal practice
business is carried out, and the decision-making process. As part of this, it would involve
discussing who attends Practice meetings, their function and the contribution that they
make, as well as showing the GP Trainee key Practice documentation such as the
Partnership Agreement and salaried GP contracts. This should give the GP Trainee a
grounding and understanding of what is involved in being a partner and running a
business before actually seeing how a Practice discusses business matters and makes
decisions.
The Practice Meetings
It is useful for trainees to be present at all the practice meetings, whether educational or
business. This is because it helps trainees to experience the working of teams and to
understand the processes that go on in the background of running a practice. There is an
expectation that trainees should be aware of the normal challenges that affect all teams
Confidentiality is clearly required of the trainee and this should be discussed with them.
It is expected that there will be few occasions where matters are so sensitive as to
exclude a trainee and it may be difficult for them to engage initially as they will need
time to settle in.
The educational meetings can be useful to the trainee for learning about safeguarding,
CPR, significant event management and other clinical discussions such as end of life
management.
Page | 28
EQUIPMENT THE GP TRAINEE WILL NEED
Consulting Room
A properly equipped consulting room for use by the GP Trainee is important, both as part
of their training and also for convenience. A proposed list of equipment that should be in a GP Trainee’s consulting room is a follows:
Desk
Drawers
Chairs (one for the GP Trainee, and two for patients)
Computer
Printer
Telephone
Bookcase/shelving
Notice board
Couch
Curtains/privacy screen
Couch steps
Height measuring equipment, wall mounted
Weighing scales
Sphygmomanometer
Otoscope and auroscope,
Examination lamp,
Eye chart
Reflex hammer
Thermometer
It is advisable to use or purchase wall mounted equipment, where it’s possible to do so,
to prevent it being removed from the room.
Other equipment:
Webcam and speakers (details in intending trainer documentation)
Dictaphone or method of recording dictaiton Doctors bag This should contain the necessary equipment and drugs for
responding to patients needs both in and out of hours. The contents of a doctor’s
bag are likely to vary depending upon the individual doctor, and where they
work; for example, the contents required for working in a rural area are likely to
differ from a city area
Suggested equipment
This list is complete, but obviously it is reasonable to expect trainees to acquire
their own basic equipment such as a stethoscope. Many trainees will build up
their own range as they develop.
Diagnostic set (otoscope/auroscope)
Stethoscope
BNF
Sphyg
Thermometer
Alcohol wipes
Disposable gloves
Page | 29
Lubricating jelly
Personal alarm
Stationery – a small number of FP10s, fitnotes, headed notepaper, envelopes
Reflex hammer
Syringes, needles, tourniquet
Tongue depressors
Multistix Drugs
Should be agreed by the practice and mirror those carried by the regular medical team
As part of the induction process, the contents of the bag should be agreed with the
Trainer. The Trainer should also make sure that the GP Trainee is aware of the following:
A bag should be lockable, and not left unattended. If placed in a car, it should be
in the boot or out of sight
Most medicines need to be stored between 4ºC and 25ºC, so the type of bag used
needs to be suitable for this requirement.
Bright lights may inactivate some drugs, so keep the bag closed when it isn’t in
use
Ensure there is a system in place to regularly check that drugs are not out of date
Procedures for emergency equipment – for example, if a defibrillator and oxygen
are kept separately for use by the first on call or in case of emergency
If some or all of the equipment belongs to the practice, what the arrangements are for returning it at the end of the rotation
Controlled drugs
Many training practices no longer carry controlled drugs but if you do, please note the
following:
GP Trainees are responsible for their own controlled drugs (CDs). They will need
to keep a record of them in their own CD book and if they become out of date, have them destroyed in accordance with national procedures. This means that
their destruction needs to be witnessed by either a police officer, the Chief
Executive of the local LAT, or the Prescribing Adviser of the local LAT.
If a GP Trainee’s CDs become out of date during their practice rotation, the
Trainer may be prepared to facilitate destruction of the CDs in accordance with
Practice procedures. This might mean, for example, that if the practice has a
locked cupboard where out of date CDs are kept until they are destroyed as per local procedures, the GP Trainee may be permitted to keep their own out of date
CDs in the same location. Local arrangements for destruction of out of date CDs
must be adhered to, so it is advisable to check these arrangements.
USEFUL URLs
British Medical Association (BMA) – www.bma.org
Committee of GP Education Directors (COGPED) – www.cogped.org.uk
Department of Health – www.dh.gov.uk
General Medical Council www.gmc-uk.org
Royal College of General Practitioners (RCGP) – www.rcgp.org.uk
East Midlands Local Education Training Board (LETB)
www.eastmidlandsdeanery.nhs.uk
Page | 30
GP Training Programme Managers
Derby Viv Longdon
Boston Avis Staff
LNR Jane Astbury
Sherwood Forest Margaret Murray
Nottingham Nicola Ruffle Lincoln Val Irons
North Nottingham Pamela Whitehurst. Useful website for downloads for induction and training:
www.pennine-gp-training.com then go to the downloads section.
K4 FORM Appointment of a GP Registrar to a Trainer/VTS in General Practice
The following form is to be completed by the VTS Co-ordinator (or nominated deputy) and GP Registrar. The information is collated to ensure that any registrar appointed to a vocational training scheme receives the correct salary and is placed on the correct pay scale. Please complete all sections of the form in BLOCK CAPITALS. Please note that the Shared Services will have difficulty in paying salaries without this information. It is therefore necessary to send this document well in advance of commencing the training post.
Authorisation is hereby given to the Shared Services to make payments (e.g. GP Registrar’s salary and expenses, GP Trainer’s grant, pay-over of employees and employers superannuation contributions etc) as set out in the “National Health Service Act: National Health Service (Vocational Training FOR General Medical Practice) Regulations 1977) (SI 1997/2817 – amended by SI 1998/669, regulation 2 (3) (a) – Directions to Health Authorities concerning GP Registrars” to the named GP Trainer and GP Registrar as per the information given above.
TO BE COMPLETED BY VTS:
FULL NAME OF REGISTRAR:
VOCATIONAL TRAINING SCHEME:
The above named registrar will be employed by the approved GP Trainer, as detailed below, in accordance with the provisions of the GP Registrar Scheme.
GP TRAINER AND PLACEMENT DETAILS:
Full Name Of Trainer:
Practice Address:
Start Date:
End Date:
No Months (Whole Time)
Start Date:
End Date:
No Months (Whole Time)
NATURE OF PROPOSED GP REGISTRAR APPOINTMENT:
As part of a recognised 3 year vocational training programme YES NO
As part of a self-planned rotation YES NO
A traditional 12 month GP Registrar appointment YES NO
Other e.g. shortened appointment for a period of additional training YES NO
Flexible training – equivalent of ……………..% wte (minimum 50%) YES NO
Innovative Training Post YES NO
GP Refresher training – full time/flexible……..% wte (minimum 50%) YES NO
TO BE COMPLETED BY THE GP REGISTRAR:
CONTACT DETAILS:
Address: (for correspondence)
Home Telephone:
Work Telephone:
Mobile Telephone:
E-mail Address:
PERSONAL DETAILS:
Date of Birth:
Country of Birth:
GMC No:
Type of Registration: (i.e. full, limited)
Name of Medical Defence:
Membership No:
SALARY AND PENSION DETAILS:
Current Employer:
Address:
Current Salary:
Incremental Date:
National Insurance No:
Superannuation No:
Are you a member of a NHS Pension Scheme:
Are you currently purchasing added years:
If so, percentage (if known)
PLEASE ATTACH A COPY OF YOUR LATEST SALARY SLIP WITH THIS FORM
Signed:
Dated:
Once completed this should be returned to the VTS office who will forward to the Shared Services on your behalf. You should also keep a copy for your records. The practice that you are placed at my also ask you to produce this document.
TRAVEL EXPENSES CLAIM FORM – GP SPECIALTY TRAINEES
PERSONAL DETAILS:
Name: Dr
Home Address:
Post Code:
CAR DETAILS / DISTANCES:
Make/Model of Car:
Engine Size:
Registration Number:
Home to hospital single………… base mileage: return………..
Home to surgery single………. mileage: return………
I have read the GP Registrar Directions (2003) with 2007 Amendments. Considering this I believe that I will be entitled to claim at Standard User / Regular User rate (please delete as applicable).
Please note this will be monitored and altered in accordance with the Directions should the trainee not meet the eligibility criteria associated with the rate of mileage.
PRACTICE DETAILS:
Trainer Name: Dr
Practice Manager:
Practice Address:
Date in post from: To:
DECLARATION:
I declare that: a) The traveling expenses and allowances claimed are in accordance with the GP
Registrar Directions (2003) with 2007 Amendments and East Midlands Healthcare Workforce Deanery policies and are in connection with official visits to the places indicated on the date(s) shown.
b) Where a claim for mileage is made: (i) Travel by a Public Service vehicle was not appropriate (ii) The vehicle has a current Road Fund License and is in a road-worthy condition complying with Road Traffic Acts. (iii) An insurance policy will continue to be maintained while the car is used by me and will cover the use of the car on official business.
c) No other claim has been or will be made by me on any public body for expenses or allowances in connection with the business stated.
Signed (Claimant) Date:
Please complete on a monthly basis and forward to your PCT/Agency for reimbursement
Travelling Home to Work The Patient Home Visits Section
Date Reason for journey/claim - excess miles return - home to hospital base
and return
Starting point, all places visited and end point (patient home visits) Total No of miles
Amount claimed (to be completed by PCT)
Totals
All claims are accurate and true to the best of my knowledge
Signed (GP Trainer/Practice Manager)……..……………..…………………………………………………………………………… Date: ……………………
Signed (GPStR)………………………………….………Print name (GPStR).....................................………………………….. Date: ……………………
Please complete on a monthly basis and forward to your PCT/Agency for reimbursement
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NEW EMPLOYEE CHECKLIST
NAME OF EMPLOYEE:
Name of form/action
Owner
Timescale
Date given to employee or sent off to relevant
organisation
Date signed/ returned by employee
Comments
CV (if applicable)
After advert
Application Form After
advert
Offer Letter/Registrar Welcome Letter
After verbal offer
Job Description
With offer letter /email
Confidentiality Agreement
With offer letter /email
NHS Pension Scheme information
With offer letter /email
Personal Details Form
With offer letter /email
Fairway Training New Starter Form
With offer letter /email
P46 With offer
letter /email
Confirmation of Performer’s List Registration
With offer letter /email
Mobile phone – required for Home Visits
With offer letter /email
Confirmation of insurance cover to drive for work purposes, and membership of recovery organisation
With offer letter /email
Medical Questionnaire & Occupational Health Form
With offer/letter
by post
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Confirm Start Date
After offer letter
returned
ID 1
After offer letter
returned
ID 2
After offer letter
returned
Reference 1
After offer letter
returned
Reference 2
After offer letter
returned
Set up induction timetable
After start date
confirmed
DBS Check
After start date
confirmed
Confirmation of Professional Body Registration
After start date
confirmed
Confirmation of Medical Defence Union Subscription
After start date
confirmed
Add to MDU Group Scheme
After start date
confirmed
Complete SAL FCS form
After start date
confirmed
K4 Form
After start date
confirmed
New User IT Form
After start date
confirmed
RA01 or Smartcard No.
After start date
confirmed
RA02
After start date
confirmed
Sunquest ICE
After start date
confirmed
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Add New User to SystmOne
After start date
confirmed
Set SystmOne toolbar preferences
After start date
confirmed
Add to SystmOne Distribution Groups
After start date
confirmed
Add to Email Distribution Groups (HIS & PM)
After start date
confirmed
Set up annual leave spreadsheet
After start date
confirmed
Add staff to birthday list
After start date
confirmed
Set up personnel file in cabinet
After start date
confirmed
Add to Staff List spreadsheet
After start date
confirmed
NHS Pension Scheme decision
Before 1st
payroll
P45
Before 1st
payroll
Copy of last payslip
Before 1st
payroll
Staff Handbook Tutorial
During 1st
week
Fire Exit & Extinguisher Tour
During 1st
week
Issue Induction Information
During 1st
week
Keys
During 1st month
Swipe Card
During 1st month
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Name Badge
During 1st month
Uniform
During 1st month
Door Name
During 1st month
Contract of Employment
During 1st month
Issue Travel Expenses Claim Form
During 1st
week
Discuss policies and procedures
During 1st
week
Issue policy and procedures statements for signature
During 1st
week
Introduce CQC & policies
During 1st
week
Introduce Business Continuity Plan and contact form
During 1st
week
Add to business continuity plan
After start date
confirmed
Diarise Probationary Review (3mth)
During 1st
week
Diarise Probationary Review (6mth)
During 1st
week
Issue mobile numbers to contact staff in case of emergency/absence
During 1st
week
Doctors bag checked & issued
During 1st
week
Update practice leaflets and website
During 1st
month
Visa information
Certificate of Sponsorship (COS) A certificate of sponsorship is a 'virtual document' assigned by an employer (which must be a licensed sponsor) to a migrant. The migrant must quote the certificate's reference number when applying for permission to work in the UK under Tier 2 of the points-based system. HEEM must give this reference number to a migrant we wish to employ because it is will be key part of their
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application for permission to come to the UK if they are overseas (known as 'entry clearance'), or permission to stay in the UK if they are already here (known as 'leave to remain'). Tier 2 (General) The Tier 2 (General) category is aimed at migrants that have an offer of a skilled job that cannot be filled by a settled worker.
Tier 1 category The Tier 1 (General) category is aimed at migrants who wish to engage in highly skilled employment in the UK. Successful applicants will be free to seek employment without having a sponsor or to take up self-employment/business opportunities in the UK. Tier 4 student The Tier 4 category is aimed at Non-UK/non-EEA nationals who graduate from a UK medical school wishing to undertake a two-year full-time Foundation Programme, (including academic programmes), are eligible to apply for Tier 4 sponsorship. Doctors from non-UK medical schools are not eligible to apply for Tier 4 sponsorship. HEEM only sponsors trainees for a Tier 2 general visa How they apply Once a trainee has accepted an offer they need to contact [email protected] or the medical recruitment inbox. They will need to provide the following documents: 1. Passport
2. Debit or Credit card with the amount of £184 available
3. Current visa
4. Offer letter/contract with commencement dates from the Trust
5. Original degree certificates (Bachelors/Masters/PhD)
6. GMC registration
It is a Home Office requirement for the trainees to provide these documents and a copy is kept for our reference. Any trainee that is sponsored by HEEM will have a folder on the EDM and the relevant section of Intrepid will be updated.
Important information The minimum salary requirement for a tier 2 visa is the amount stated on the COS, which is usually the minimum salary for a ST1 specialty registrar, as stated on NHS Employers website. A trainee on a tier 2 visa should not go below this amount at any point in their training. If the new rate of pay is less than this amount then we must inform the Home Office immediately. The only exceptions to this rule are where the reduction is due to the migrant taking a period of: 1. maternity leave
2. paternity leave
3. adoption leave
4. long-term sick leave in excess of one continuous calendar month This must be reported to the Home Office within 10 days. Trainees must remain within the East Midlands at an approved training site in order for HEEM to continue sponsoring the trainee. Anything outside this would require a change of sponsor. A trainee cannot leave training and return to the same post, without reapplying in open competition, unless they keep the same NTN. This is due to the trainee being required to satisfy the Resident Labour Market Test (RLMT).
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RLMT means that you must advertise the job you wish to recruit to; to give settled workers a chance to apply. If you find that you have more than one candidate with all the necessary skills and experience you advertised for, where one is a settled worker and the other is a migrant, you must appoint the settled worker even if the migrant is more skilled or experienced. Exemptions from the resident labour market test are: 1. Continuing to work in the same occupation - If the migrant is already working for you and they need to
extend their leave to continue working for you in the same occupation, you do not need to conduct a
resident labour market test.
2. Shortage occupations - Shortage occupations are ones where there are not enough settled workers to
fill available jobs in particular sectors
3. Post-study work - You do not have to conduct a resident labour market test if a migrant you want to
sponsor is applying for Tier 2 (General) leave, in the UK and has a tier 4 visa.
4. The trainee has had an OOP and is returning to the same NTN. Please note that if a trainee has an OOP outside of the UK they will be subject to a ‘cooling off’ period of 12 months before being allowed to re-enter the UK
Glossary COS – Certificate of Sponsorship RLMT – Resident Labour Market Test PSW – Post Study Work PBS – Points Based System SOC – Standard Occupational Code ILTR – Indefinite Leave to Remain
SAMPLE EMAIL FOR NEW GP REGISTRAR
Good Morning {INSERT NAME OF GPT}
You will be joining {INSERT NAME OF PRACTICE} at the beginning of {INSERT MONTH} for your {INSERT DURATION} month placement. In advance of your start date, it would be very helpful for us to have the following paperwork from you:
1. Signed confidentiality agreement (attached) 2. Completed Personal Details form (attached) 3. New employee form (attached) 4. P45/46 or recent payslip (P46 attached) 5. 2 forms of ID – 1 picture, 1 to confirm address (e.g. utility bill) 6. Copy of up to date DBS Clearance 7. Your Smartcard number 8. Confirmation of Performers List Registration 9. Current Hep B status evidence 10. Confirmation of car insurance for Business purposes 11. MDU/Travel claim forms attached for your use – please complete and return to me as
appropriate 12. Please ensure you contact the LETB for your K4 form and ensure it is completed and
returned directly to them
If would be helpful to arrange an opportunity for you to visit the practice, meet your trainer and some of the team in advance of your start date – please can you suggest a few suitable times for you and we will confirm the best option for us? It would be ideal if you could bring this completed paperwork with you on this visit.
We look forward to meeting you soon.
Regards
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INDUCTION INFORMATION
Welcome to {INSERT NAME OF SURGERY} - we hope you will enjoy your time with us.
The practice is committed to training and whilst you have a named trainer who will carry out the majority of your assessments, the whole practice is involved in training so feel free to ask any of the doctors for support.
We have produced this pack to support your learning whilst you are with us. We will be asking at intervals for feedback on your experiences here. It is very important you are as frank as you can be so we can ensure you have the best possible educational experience.
You will see from your weekly rota that you are expected to be an important part of our team. We feel you have appropriate time for formal education in your weekly plan but an important part of your attachment is to see patients and gain experience. If you have time in your surgeries, or patients do not attend, please look at the On Call doctors list and see if you can help. We do not expect you to leave before 6.30pm to ensure you and the other team members are aware of the On Call doctor being supported.
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“TO DO” LIST FOR NEW STARTERS
Completed
1. Give advance notice of new staff arrival to partners and staff
2. Inform staff and registrar of timetable
3. Meet/speak to new registrar at pre-job visit a month before start date
4. Confirm any prebooked holidays
5. Send introductory email with list of required documentation
EDUCATION FACILITATORS INDUCTION SESSION
Completed
6. New contract & QOF and achieving our targets
7. Choose and Book & referral procedures, patient notes, x-ray and dictating
8. Letters and hospital post
9. Stationary and forms – where to find them
10. The Library
11. Sunquest Ice (pathology request) trainers to explain
12. Sunquest Ice (handling of results) trainers to explain
13. Nurses Cupboard/rooms – show emergency bag, nebuliser and defib
14. Doctors bag/Registrars room – trainer to explain fully
15. Discuss – OOH (through night cover Fri & Sat only) if doing a late (6pm-10pm) OOH – to have a late start) Registrars to arrange. Must give Practice Manager 6 weeks notice to rearrange clinics for late start.
16. Training plan of clinics
17. Prescribing
Prescribing scheme
Scriptswitch
Black & red drugs
Formulary
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PRACTICE MANAGER INDUCTION SESSION
Completed
18. Organisational structure - how to address & who does what
19. Payroll - inform paid by BACS on second to last working day of the month
20. Staff handbook
21. Contract – for registrars standard BMA will be provided in next two weeks. Holiday/Sickness leave – contact trainer and/or Practice Manager if sick as well as Reception Supervisor – number to be provided
22. Shared drive
23. Rota and appointments
24. Fire procedure, fire alarms and other health & safety
25. Security, thefts, how to open locks
26. QOF, read codes, searches & audits
27. Enhanced services, CCG schemes. Prescribing schemes
28. Private work – fees first and via reception
29. Confidentiality
30. Car parking – discuss barriers and spaces
31. Distribution of work – pathology, prescriptions, correspondence. Shared equally and done on the same day
32. Communication – coffee, pigeon holes, notifications and tasks, external email, text
33. Direct dial numbers for reception, trainer and managers and mobile numbers
34. Meeting Schedule
Frequency
Role
Attendance
Minutes
35. Safeguarding policies, procedures and training
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STRUCTURE OF TRAINING Debriefs:
When timetabled
Debriefs shared out between GPs Shared Surgeries: You will see 3 patients (20 minute slots) with another doctor observing (usually your trainer).
Outside Tutorials and study days: Registrars have a number of these up to a maximum defined by the study leave in their contracts.
Surgeries: Registrars will work a 10 session week. At the start, trainees are likely to need 20 minutes per appointment. As they become more confident and competent, by the end of their training they should aim to need 10 minutes. As the amount of time reduces, agreement between the trainer and the trainee will be necessary to ensure this is at an appropriate pace.
Visits Registrars will begin to do home visits in a supported way after 3 months in practice.
Registrar Appointment Lengths as a suggestion, to be discussed at each stahe to see if approporiate:
Year 1 – 17 weeks Induction Week 1 10 min appts Week 2-3 15 min appts Week 4-12 10 min appts Week 13-14
Week 15-16 Week 17
Year 2 – 17 weeks Induction Week 1 15 min appts Week 2-3 10 min appts Week 4-5
Week 6-7 Week 8-9 Week 10-11 Week 12-17
Year 3 – 52 weeks Induction Week 1 15 min appts Week 2-3 10 min appts Week 4-5
Week 6-7 Week 8-9 Week 10-52
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Find out in reception:
Done
Where are? Coffee and tea facilities? The Loos? Fire Exits? GP Registrar parking space?
Appointments: How do you make an appointment?
Prescriptions: How do patients get a repeat prescription? What do you do with the prescription once you have signed it? 48 hour rule
Communication: What do you do with your box? Where is your in-tray? Where is the white board and what is it used for?
Visits: What is the procedure for being told about visits? How do you record the visit in the computer record?
Telephone Advice: When are you available on the telephone?
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Find out from the secretaries:
Done
Referrals and letters: What is Choose and Book – how to fill in a Choose and Book form. How do refer a patient Envelopes from secretaries 2-week rule Urgent referrals
Patients Transport: How do we arrange transport to hospital? What information does the receptionist need to know from you before she can book the transport?
Certification: When do you give a certificate? A state one or a private one?
Patient Call System & Panic Alarm: How do you call patients in? What is the procedure for the panic alarms?
Access to Other Resources: Social Workers CPN Chiropodist Counsellor School Nurse CAB and voluntary agencies Adur Carers Association
Drug Company Representatives: When/if would you prefer to see them?
HGV medicals & Other private work: When do you do these? How do you charge the patient?
Policies/Protocols/Procedures: Located on the shared drive
Health and Safety: Read the Health and Safety handbook
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Find out from the Practice Manager:
Done
Timetable: What is your timetable? What is a normal duty session? Which days are you on duty from 8am? Which days are you on duty till 6:30pm
Rota: Where is the on call rota kept?
Booking Holidays: How much holiday are you entitled to? How do you go about booking holiday? Who needs to be informed? Where is it recorded?
Study Leave: How much study leave are you entitled to? How do you arrange to take extra study leave/ swap for surgery?
Sickness: If you are off sick how do you let the practice know?
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Find out from the nurses:
Done
What do the Practice Nurses do?
What does the HCA do?
How do you arrange for a patient to see the Practice Nurse?
What does the Health Visitor do?
What do the District Nurses do?
How do you arrange for a patient to see the District Nurse?
Pathology: How do you get pathology results? Paper? On Computer? How do you arrange a blood or urine test and how do the results get back and transmitted to the patient? What GP code and Doctor identifier should you put on the forms? What time is the blood collected to go to the lab?
X-rays: How do you arrange them?
ECGs: How do you organise them?
Dopplers: How do you organise them?
Cryo clinics: When are cryo clinics?
Smoking Clinics, Diabetic Clinics, Asthma Clinics When are these clinics?
Equipment: Where are the Ophthalmoscope, ecg, coaguchek – other equipment kept?
Emergency Equipment: Where is the defibrillator, oxygen and other emergency equipment? What is the Resuscitation procedure?
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Learn how to do the following:
Done
General SystmOne (or other clinical system) training: i. Logging on to Windows ii. Logging in to SystmOne iii. Function keys iv. Shortcuts v. Finding patients vi. Diary vii. Major alert messages viii. Play patients
Consulting in SystmOne: i. The consultation screen ii. Calling patients in & indicating patient has left iii. Finding out the status of the patient with respect to the New Contract
(F12) iv. Add Coded information – problems and non-problems v. Reviewing problems vi. Soap codes vii. Looking at attached documents viii. Looking at secretaries letters ix. Summary and access to medical records x. Adding past information xi. Auto consultations xii. Referring – What codes do you need to use when making referrals? xiii. Using Templates
Results: i. Looking at & filing pathology linked results ii. View sections: looking at grouped values iii. Patient notes
Read Codes: i. Read code classification ii. Finding Read codes iii. Read code hierarchy iv. Groups and sub groups v. Practice codes vi. Access system
Prescribing: i. Adding a prescription
a. Selecting the drug b. Prescription types c. Prescription duration d. Review dates
i. Restarting a past drug ii. Detailed display iii. E-mims
Page 10 of 10 Created on: Created by: Last revised: Last reviewed:
iv. Browsing the BNF v. Mentor
Quick ways to do things: i. Prodigy ii. Quick keys iii. Auto consultations
Searches: i. How to find out the results of existing searches ii. Browsing through search results iii. Quick searches iv. Adding a search v. Population Manager
GMS Contract: i. What is the GMS Contract? ii. Global Sum iii. Quality Payments iv. Enhanced and Community Based Services v. QOF
Communication: i. E-mails ii. Meeting schedule iii. Address Book iv. Tasks
GPC General Practitioners Committee
April 2002 (revised December 2007 and March 2014)
Committee of General Practice
Education
Framework for a written contract of employment Compiled in conjunction with BMA regional services and based on a document produced by Wessex LMCs
Guidance for GP Specialty Trainees
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Framework for a written contract of employment
Note for those drawing up the contract of employment and appendices
* or [ ] indicates a note, information needed to complete the contract, an alternative to be deleted, or a section which may not be appropriate for all staff in all circumstances, e.g. maternity leave clause.
{ } draws your attention to the notes for this framework.
GP Specialty Trainee
Referred to in this contract as ‘GPST’
This agreement sets out particulars of the terms and conditions agreed between:
[Insert name of the employer] (the trainer/educational supervisor/lead employing organisation)
Address: [ ]
and you:
Name: [insert GPST’s name ]
Address: [ ]
on: [insert date ]
Appendix 1 sets out your timetable
Appendix 2 sets out the disciplinary procedure
Appendix 3 sets out the grievance procedure
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[Please note that the procedures contained in Appendices 2 and 3 are examples only and practices are advised to ensure that these reflect their own established disciplinary and grievance procedures]
Appendix 4 sets out the educational agreement between you and the
trainer/educational supervisor.
Appendix 5 sets out the accompanying terms and conditions of service as contained
within the handbook for GPSTs.
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Terms and conditions
1. Job Title Your job title is GP Trainee in the GP Specialty Training Programme of [state the name of LETB/Deanery]
2. Terms and conditions of service Your appointment is subject to you being a member of the relevant performers list.
Your appointment is also subject to the terms and conditions outlined in this contract, the accompanying handbook of terms and conditions of service for GPSTs in general practice and the terms of service for general practitioners as set out from time to time in the National Health Service (General Medical Services Contracts) Regulations 2004 (or equivalent).
3. Date of start of employment Your employment begins on [insert start date]
4. Period of employment This employment is for a fixed term of [insert length of contract]. It will therefore terminate on [insert end date] except where a further period of training is considered necessary. There is no guarantee that any extension will be in the same practice as your current employment. Extensions are subject to the approval of the local Director of Postgraduate GP Education.
5. Occupational health assessment The appointment is subject to occupational health requirements being met. Assessment may include a requirement that you submit to a medical examination by a medical practitioner acceptable both to you and the trainer/educational supervisor.
You may also be asked to consent to an examination by a medical practitioner, agreed by you and the trainer/educational supervisor, in circumstances where the trainer/educational supervisor has reasonable grounds to be concerned about your health and your fitness to undertake the work for which you have been employed If there are health reasons that may impact on your training in addition to your employment this will also need to be acceptable to your LETB/Deanery. You may also be requested to consent to the release of your medical records to the nominated medical practitioner if such records are reasonably required by him or her.
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In the event of an unsatisfactory occupational health assessment or that you do not wish to consent to either medical examination or the release of your medical records as referred to above, then the trainer/educational supervisor, advised by the Director of Postgraduate General Practice Education, will make a decision on your continued employment on the basis of the information available and in the absence of an independent medical expert’s opinion.
6. Salary and allowances The employer shall pay a salary and a motor vehicle allowance at rates in accordance with the Schedules to Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent), as amended from time to time, concerning GPSTs.
Your basic salary will be [£………pa.] Your salary supplement will be [£……..pa.] Both annual salary and supplement will be amended in accordance with the annual recommendations of the Doctors’ and Dentists’ Review Body as implemented by government for GPSTs in the Schedules to Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent) l payments will be made in arrears at the end of each completed calendar month, by payment into a bank or building society account, or by cheque.
7. Deductions The employer will not make deductions from or variations to your salary other than those required by law without your express written consent.
8. Hours of work (a) Your hours of work in the practice, your programme and regular periods of tuition and
assessment will be agreed with you. Both during and outside normal hours, they will be appropriate to your educational needs and shall be bound by the provisions of the UK Working Time Regulations. Information regarding local arrangements for the working week can be found on your local LETB/Deanery website.
(b) The normal working week (excluding out-of-hours training) will comprise of 10 sessions
which will be broken down as follows: 7 clinical, 2 structured educational (including the structured teaching programme of the scheme) and 1 independent educational session. A degree of flexibility may be required from time to time in order to meet your training needs i.e. increasing either the number of educational or clinical sessions in order to gain specified competencies (having decreased the number of clinical or educational sessions accordingly/respectively). The nominal length of a session is 4 hours.
(c) You are an integral part of the practice team but you are supernumerary to the workforce
of the practice. At no point should the effective running of the practice be dependent on your attendance and you will not be used as a substitute for a locum in the practice.
(d) Out of hours: the GP trainer/educational supervisor will ensure that you have completed
necessary out-of-hours experience in line with Chapter 7 of the RCGP Curriculum, ‘Care
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of Acutely Ill People’ and recorded this in your e-portfolio. This evidence will also be taken into account in the considering your progression (Annual Review of trainer/educational supervisors report. The trainer/educational supervisor should be able to facilitate the booking of out-of-hours sessions. Out-of-hours sessions should not normally be started before you have completed one month of employment at the practice, and should be completed in sufficient time for the enhanced trainer/educational supervisors report to be completed on time and a ‘Recommendation for Completion of Training‘ (usually 6 weeks prior to completing training). It is your responsibility to book and attend the required out-of-hours sessions within this window.
(ii) You will be required to undertake sufficient out of hours experience to gain and demonstrate the required competencies. This should include a benchmark 6-hours of out-of-hours training for each month of FTE placement in General Practice. An out-of- hours clinical supervisor will make themselves available at all times when you are undertaking out-of-hours duties.
[(e) Less than Full Time training will fulfil the following requirements:
(i) A one-week mandatory period of full-time training, as meets the requirements of
the appropriate assessing authority
(ii) A minimum of 50% of normal working week to be worked (including tutorials and protected educational time each week)
(iii) Training in unscheduled care work will be undertaken to achieve the
competencies stated as directed in Chapter 7 of the RCGP Curriculum, ‘Care of Acutely Ill People’.
(iv) All arrangements relating to part-time training are subject to approval by the
Director of Postgraduate GP Education.
(f) Your normal timetable is attached as Appendix 1.
9. Pension You will be offered the opportunity to join the NHS pension scheme and your employer can arrange for the deductions from your salary and account to the proper authority for all contributions or other payments for which you are liable under the scheme. The NHS pension scheme is contracted out of the State Second Pension ('S2P', formerly SERPS) and a contracting out certificate is in force.
Please note that if you decide to opt out of NHS pension scheme membership NHS employers are obliged to auto-enrol eligible staff into the NHS pension scheme every three years. If you have opted out of the scheme in order to retain certain HMRC protections you will need to opt- out of scheme membership again, within one month of auto-enrolment, for the protection to still be valid.'
10. Notice of termination of employment
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a) This contract may be terminated by you giving one month’s notice in writing to your employer giving one month’s notice in writing to you, and such notice may be given at any time.
b) These arrangements shall not prevent either party waiving his/her rights to notice on any occasion, or accepting payment in lieu of it.
c) Either party may treat the contract as terminable without notice, by reason of such conduct by the other party that constitutes a breach.
11. Location and duties (a) The trainer/educational supervisor undertakes to teach and advise you on all matters
appertaining to general medical practice and offers employment/placement to further this purpose.
(b) You will be required to work at the surgery premises at [insert location]
You may also be required to work at surgery [X] or [Y] or such other localities as may be reasonably necessary for the performance of your prescribed duties.
(c) You will be required to travel to provide home visits, emergency treatment, etc. to
patients, and to undertake other duties outside the surgery as required for the purposes of GP training.
(d) Save where you are required to provide or assist with an educational presentation, or for
your own educational benefit, you will not be required to perform duties which will result in the receipt by the practice of private income, unless an arrangement to the contrary is entered into before the commencement of your GP Specialty placement (this may include writing private sick notes). Any such agreement to the contrary shall specify the extent and nature of the duties that may be required.
(e) A suitable supervisor will be available to provide support at all times when you are
working in general practice. The supervisor will be a qualified GP and, in the event that your named clinical or educational supervisor is not immediately available, another qualified GP will be nominated for the specific session and will be supported by your named supervisor.
(f) You are required to care and be responsible for, maintain and, if necessary, replace and
return at the end of the training period any medical equipment or supplies made available to you by the trainer/educational/clinical supervisor during your employment.
(g) Complaints: If you are required by your employer to participate in any complaint
investigation or hearing in the practice under the NHS complaints procedure, you must be available. This requirement extends after your employment with the practice ends, providing you are then still in the United Kingdom, and includes attendance at any independent review procedure or disciplinary hearing if your presence is required
(h) You will be required to record all such complaints and Significant Events in your RCGP
e-portfolio. These will be noted at annual review of progression as this is a requirement of the GMC Revalidation processes
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Reasonable expenses of travel and subsistence will be met and wherever possible reasonable notice will be given.
12. Professional registration and indemnity You are required to effect and maintain full registration and a licence to practise with the General Medical Council and to effect and maintain membership of a recognised medical defence organisation approved by the employer commensurate with your professional duties, throughout the period of employment. Initially this will be at your own expense but full reimbursement of the cost of basic medical defence cover can be claimed from the employer.
You are required to produce evidence, in the form of original documents, of such full registration and defence organisation membership before commencing your duties, and similarly to produce original evidence of retention of registration and renewal of defence organisation membership from year to year to demonstrate continuity.
Failure to maintain full General Medical Council registration or commensurate defence organisation membership, including suspension or erasure from the register and the imposition of conditions on your registration, will entitle the employer to suspend you and to instigate the disciplinary procedure attached at Appendix 2.
13. Fees (a) All fees received by you in relation to the care of the patients (past and present) shall be
paid to the practice or as they may direct. (b) Any specific or pecuniary legacy or any gift of a specific chattel shall be considered your
personal property.
14. Outside activities (a) With the agreement of your trainer/educational supervisor, you may arrange to
undertake any duties or professional activities outside those of the practice whether remunerated or not. Agreement will not be unreasonably withheld. Any medical duties or appointments outside the practice area must not compete with the trainer/educational supervisor’s practice or impinge on your contracted duties with the practice, or upon your GP specialty training. This applies equally whether such duties are remunerated or not. Such duties should not lead to a breach in UK Working Time Regulations. Consent does not imply any responsibility by the employer for your acts and omissions in the course of such activities. You are advised to ensure that your membership of a recognised medical defence organisation is commensurate with these activities.
(b) If you are elected to represent other GPSTs on recognised bodies [define if possible] or
to attend the annual conference of representatives of LMCs you will be given facilities including special paid leave, to undertake such functions and to attend appropriate meetings. You must obtain the consent of your trainer/educational supervisor and employer to each absence from duty but consent shall not be withheld unless there are
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exceptional circumstances in the reasonable opinion of the trainer/educational supervisor. You should wherever possible inform your trainer/educational supervisor of any such commitments before you commence your attachment. When agreed such absences shall be considered as included in working time commitment. If such commitments significantly impact upon your learning an extension to training may be required at the discretion of the Director of Postgraduate GP Education.
15. Confidentiality Subject to your statutory rights and duties and to the necessary sharing of information with other health professionals, with the informed consent of the patient, you are required to preserve the absolute confidentiality of the affairs of the trainer/educational supervisor, of the partners, of the patients and all matters connected with the practice and the employer. This obligation shall continue even after the contract of employment has ended. A breach of this requirement will be regarded as gross misconduct and as such will be grounds for dismissal, subject to the provisions of the disciplinary procedure. Further details are given in part 2 of the accompanying handbook of terms and conditions of service for GPSTs in general practice, clause 5.
16. Records You will keep proper records of attendance, visits by and to patients and all other such records as are required by NHS legislation, or are reasonably required by the training practice/employer.
17. Prohibited acts You will not:
(a) hold yourself out to be in partnership with the trainer/educational supervisor or other
partners of the practice (b) pledge the credit of the partners of the practice
(c) do anything which shall cause the reputation of the trainer/educational supervisor or
other partners of the practice or the employer to be brought into disrepute (d) publish (except with the written consent of the trainer/educational supervisor) any
documents, articles or letters, etc which may purport to represent the practice or the views of any of the partners.
18. Transport You must either hold a current valid driving licence and have use of a motor vehicle, or provide alternative means of offering emergency and domiciliary care to fulfil the requirements of the post
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Note: It is necessary to notify your insurance company that you intend using your motor vehicle for business purposes, before doing so. Otherwise your insurance cover may be inadequate.
You will be required to:
(a) provide, maintain and pay all the running costs of suitable transport to enable efficiently
to carry out your responsibilities under this agreement (b) conform to the appropriate statutory requirements relating to motor vehicle insurance
(c) [supply the trainer/educational supervisor with satisfactory evidence of compliance with
such requirements.].
A motor vehicle allowance at rates in accordance with the Schedules to Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent)as amended from time to time, concerning GPSTs, is payable to you for this purpose].
19. Telephone (a) You are required to keep connected to either a public or mobile telephone service. The
employer will reimburse telephone rental costs where appropriate and such proportion of the cost of calls that represent use for and on behalf of the practice. Itemised bills indicating such calls should be presented to the practice manager for payment as appropriate.
(b) The trainer/educational supervisor will organise and fund any message taking facilities
required for you when on call.
20. Leave 20.1 Annual leave
You are entitled to twenty-five/thirty* days paid annual leave per annum for full time employment. [GPSTs on the third or higher incremental point are entitled to 6 weeks leave, those below the third point are entitled to 5 weeks. This ensures equity between GPSTs and their hospital colleagues and is in line with paragraph 205 of the Hospital Medical and Dental Staff Terms and Conditions of Service 2002].
Reasonable notice must be given of your intention to take leave. You must discuss the proposed dates with the trainer/educational supervisor and have them agreed. Leave dates must be agreed before booking holidays. Such agreement will not be unreasonably withheld. If you have exceeded leave entitlement at the date of leaving the practice, for whatever reason, the employer will be entitled to deduct a sum equivalent to the salary paid in respect of such excess leave from your final salary payment. Additional leave must be notified to the Director of Postgraduate GP Education to determine whether an extension to training will be required. Payment may be made in lieu of leave owing at the end of the post.
20.2 Bank and public holidays
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Subject to the provisions of this paragraph, you are entitled to eight bank and public holidays or days in lieu per calendar year and any public holidays proclaimed from time to time. When you are required to work on one of these days on a rostered basis you will be entitled to a day off in lieu. [If you work part-time, you will be entitled to bank and public holidays or days in lieu on a pro rata basis according to the number of hours you work compared with full time hours.]*
20.3 Study leave
(a) A study leave allowance of [state number of days - not less than 30] days approved
study leave will apply. This will include attendance at a structured teaching programme, on full pay and allowances during the period of placement in a training practice and pro rata for shorter periods or part time training. Study leave requests may be agreed between you and your trainer/educational supervisor subject to approval by the Director of Postgraduate General Practice Education. Such requests should be made in line with guidance issue by your LETB/deanery and will not be unreasonably refused.
(b) Attendance on structured teaching programmes is a condition of employment.
20.4 Sick leave
(a) If you are absent due to sickness and provide proper notification, payment will be made
in accordance with the employer sick pay scheme contained in clause 3 of the accompanying handbook of terms and conditions of service for GPSTs in general practice.
(b) Where payments received under the practice sick pay scheme are less generous and
you fulfil the qualifying conditions in respect of sick leave set out in the directions to health authorities concerning GPSTs, you will be entitled instead to be paid by the trainer/educational supervisor, as part of your emoluments, such sums as are received by the trainer/educational supervisor during your sick leave.
(c) Any payment under the statutory sick pay scheme will be offset against your entitlement
as stated in (a) or (b) above. (d) You must notify the trainer/educational supervisor of any absence due to sickness on the
first day of sickness. A self-certification form should be completed for any sickness absence lasting for fewer than seven days. If the sickness absence lasts longer than seven days you must first notify your absence and also request a self-certification form which should be posted to the practice at the end of the first week of absence. If the absence continues beyond seven days a medical certificate should be submitted from your own registered GP.
(e) You should register with a local GP for medical care and normally should not be
registered with your training practice. (f) If sickness absence exceeds 2 weeks per annum you may be required to extend your
training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor and the RCGP Certification Unit. This will be a
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pro-rata arrangement for flexible training posts and for those posts that are less than 12 months in duration.
20.5 Maternity/paternity leave
(a) Maternity/paternity rights in this employment are as set down in the Schedules to
Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent) supplemented by clause 7/8 of the accompanying handbook of terms and conditions of service for GPSTs in general practice.
(b) Continuous service is calculated by taking into account previous work for an NHS Trust,
PCO, Strategic Health Authority, Health Authority or as a GP Specialty Trainee in General Practice (or any of the predecessors in title of those bodies or the equivalent bodies in Wales, Scotland and Northern Ireland). A break in service may for this purpose should be disregarded if it is:
Three calendar months or less between termination of employment with one
Strategic Health Authority and resumption with another.
Three calendar months or less between GPST posts.
Or less than six calendar months spent in employment of a person providing primary medical services to the National Health Service pursuant to a general medical services contract, a personal medical services agreement or an alternative provider medical services contract (under section 16cc(2) of the National Health Service Act 1977),
Or a period of up to six months spent abroad as part of an approved vocational training programme on the advice of a Postgraduate Dean or College or Faculty Adviser in the specialty concerned.
(c) If you are absent on maternity/paternity leave, and you fulfil the qualifying conditions in
respect of maternity/paternity leave set out in the Directions, you will be entitled to be paid by the employer as part of your emoluments, such sums as are received by the employer for the GPST’s salary during maternity/paternity leave.
(d) After maternity/paternity leave for the balance of your training period, you will be entitled
to continue your training under no less favourable terms and conditions as set out in this original contract, in an equivalent training position and where possible, with the same trainer/educational supervisor. If this is not practicable because of a change to the previous training post (e.g. a clinical/educational supervisor is no longer working at the practice) you will be offered any other suitable vacancy. Your rights in this regard are set out in the relevant legislation. You may be required to extend your training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
20.6 Unpaid leave
Unpaid leave other than for parental, dependent (including adoption) or maternity purposes is normally granted only when you have exhausted your annual leave entitlement. This type of leave is discretionary and permission must be obtained before it is taken. Unpaid leave may be granted only in exceptional circumstances if and when the needs of the practice allow. You may
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be required to extend your training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
20.7 Dependant, parental and adoption leave
Details of your statutory entitlements to dependant and parental leave are contained in clauses 4, 5 and 6 of the accompanying handbook of terms and conditions of service for GPSTs in general practice except that previous service in the NHS will count. You may be required to extend your training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
20.8 Special leave
Special leave [with/without] pay may be taken at the discretion of the employers and the deanery where appropriate. Requests for special leave should be submitted to the practice manager/named partner responsible for staffing in the first instance. Such leave may only be taken when written approval has been given on behalf of the practice. You may be required to extend your training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
21. Training assessment (a) You are required to undertake the Membership of the Royal College of GPs MRCGP)
assessment and abide by the regulations as laid down by the RCGP. (b) You are required to register with:
Royal College of General Practitioners certification unit as appropriate [insert address and telephone number of relevant body]
22. Review of progress Time will be set aside with your trainer/educational supervisor on at least every three / four months [dependent on rotation] to discuss/review your progress with your training. Adequate notice will be given prior to this review and it is an opportunity to discuss the job and other matters of concern or progress.
23. Health & safety at work
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(a) The practice’s policy on health and safety at work is to provide such safe and healthy working conditions as is possible and to enlist the support of their employees towards achieving these ends. Full details of the practice policy are contained in part 2, clause 10 of the accompanying handbook on terms and conditions service for GPSTs in general practice. While the overall responsibility rests with the employer, all staff have a legal duty to take reasonable care to avoid injury to themselves or to others by their work activities, and not to interfere with or misuse any clothing or equipment provided to protect health and safety.
Any accident or injury arising out of your employment must be reported immediately to the practice manager or partner on duty and recorded in the accident book.
(b) The main hazards that you should be aware of are: medical instruments, the disposal of
waste materials, which may be sharp, contaminated or both, contact with infectious diseases, prams and bicycles. You must report any accident immediately to the trainer/educational supervisor or in his/her absence a partner and a record will be kept at the surgery. A factual statement covering to the fullest possible extent all the circumstances of the accident may be required to ascertain the cause in order to prevent its recurrence.
(c) Legislation in England, Scotland, Northern Ireland and Wales prohibits smoking in all
enclosed public spaces. (d) Health and safety executive office: Health and safety executive
[insert address and telephone number of relevant local H&SE office]
24. Convictions/offences/GMC proceedings/discipline and suspensions/ Protection of Children Act 1999 List checks
This employment is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (or equivalent). You are not therefore entitled to withhold information requested by the employer about any previous convictions you may have, even if in other circumstances these would be regarded as ‘spent’ under the Act.
You are further required to declare the following to the, employer before commencing your duties:
(a) any suspension for whatever cause, from your contracted duties with previous
employers or other contracting parties, such as health authorities or primary care organisations, and the cause thereof, whether or not any disciplinary proceedings followed;
(b) any disciplinary sanctions (including dismissal) imposed upon you by previous
employers or contracting bodies and the cause thereof. For the sake of clarity, this shall include any findings of a breach of the GP terms of service under the NHS (General Medical Services) Regulations (or equivalent) as amended from time to time.
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(c) any sanctions imposed upon you in the past by the GMC, including any which have a continuing effect, such as conditions placed upon your registration, and any interim suspension from the register prior to further proceedings being considered;
(d) any sanctions imposed upon you by foreign regulatory bodies comparable to the GMC, if
you have worked abroad; (e) any GMC proceedings pending at the time of your application for this post or prior to the
commencement of your employment. Concealment by a failure to disclose such information may result in your dismissal.
Additionally, as this employment will require you to work with children, it is subject to checks being made with the Disclosure and Barring Service (DBS) as regards your suitability to work with children. Signature of this contract will provide your consent to such checks being undertaken, if this has not already been given during the recruitment process.
If you do not agree to such checks being made this will entitle the employer to terminate your employment by appropriate written notice.
You are further required to report to the employer:
any police investigations or criminal proceedings (including for alleged traffic offences) to
which you are subject at the time of your application for this post, or prior to the commencement of your duties with the employer;
any convictions, cautions or alleged offences with which you are charged (including traffic
offences) while you are under contract with the employer; any GMC proceedings to which you are or become subject, including any initial referral, as
soon as you become aware of these. Failure to reveal such information may result in your dismissal.
25. Educational agreement Appendix 4 (an educational agreement between a trainer/educational supervisor and a GPST) will be respected by you and the trainer/educational supervisor as a statement of your educational aims and objectives and signed by both as a record of an agreement.
26. Disciplinary and grievance procedures These procedures are attached as Appendices 2 & 3
27. Personnel policies and working procedures Currently the following personnel policies and procedures apply in this practice:
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[list policies/procedures] and can be seen on request to the practice manager.
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Appendices to be attached
Appendix 1 Timetable of hours of work
Appendix 2 Disciplinary procedure
Appendix 3 Grievance procedure
Appendix 4 Your educational agreement
Appendix 5 GP Specialty Trainee handbook Signed trainer/educational supervisor
This [insert date of contract]
I acknowledge receipt of this contract of employment and agree to be bound by it.
I understand that you will retain a copy of this signed contract
Signed GP Specialty Trainee
This [insert date of contract]
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Appendix 1 (Clause 9 refers)
Hours of work 1. The agreed arrangement of your normal working week is as follows:
AM
PM
Monday
Tuesday
Wednesday
Thursday
Friday
2. In addition to the above normal working week, you will be required to undertake out-of- hours training as referenced in paragraph 8(d) of the BMA’s Framework for a written contract of employment
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Appendix 2
Disciplinary rules and procedure
1. Preamble
1.1 Rules and procedures are necessary for promoting fairness and order in the treatment of
individuals in matters of discipline and assist a practice to operate effectively. Rules set standards of conduct and performance at work; procedures help to ensure that the standards are adhered to and also provide a fair method of dealing with alleged failures to observe them.
1.2 This disciplinary procedure is not primarily a means of imposing sanctions. It is
designed to emphasise the need for and to encourage improvements in individual conduct and performance.
1.3 In any disciplinary hearings you have the right to be accompanied by a friend, colleague
or representative. 2. Seriousness of misconduct or inadequate performance
There are varying degrees of seriousness of misconduct or inadequate performance, so the procedure outlined below may be commenced at any stage depending on the apparent severity of the matter in question.
3. Gross misconduct
Gross misconduct could justify summary dismissal. Examples of gross misconduct are: breaches of confidentiality; theft; fraud; deliberate falsification of records; fighting; assault on another person; deliberate damage to property; serious incapability through alcohol or being under the influence of illegal drugs; abuse of medicines; serious negligence which causes unacceptable loss, damage or injury, or gross act of insubordination.
4. Suspension
4.1 If it is alleged you have committed gross misconduct you will normally be suspended
from work on full pay, initially for no more than [five] working days and subject to review, while the practice investigates the alleged offence. If the allegations appear to be substantiated or are admitted, this may lead to the commencement of disciplinary proceedings against you and, thereafter, to dismissal.
4.2 Suspension on full pay may also be used where appropriate in other circumstances, e.g.
on health grounds for the protection of staff, patients or public or for less serious disciplinary matters than alleged gross misconduct, where the nature of the complaint is such that investigations could be hindered or compromised by the continuing presence of the member of staff concerned.
4.3 Suspension is not a disciplinary sanction. The reasons for, and length of, suspension
will always be confirmed in writing. The employer will exercise the power of suspension.
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5. Enquiry You will always be informed of the complaints against you and be given an opportunity to give an explanation before a decision is reached on whether or not to take matters further.
6. Informal action
If your conduct or performance at work is causing concern without satisfactory explanation, you may be asked to attend to discuss the matter in more detail with the trainer/educational supervisor and possibly the director of postgraduate general practice education. Where appropriate counselling or further training may be needed. It is hoped that this informal action will resolve any possible difficulties and lead to the required improvement.
7. Formal action
7.1 Written warning: If informal action is inappropriate or ineffective, there will be a formal
meeting. You will be given adequate written notice of the meeting, which will take the form of a disciplinary hearing, and the allegations against you will be clearly set out in writing. You will be entitled to be accompanied by a colleague or trade union representative. You will be able to reply to the allegations during the hearing. If, following this, disciplinary action is deemed appropriate; a written warning will be given. The nature of the misconduct or inadequate performance will be stated and the nature of the disciplinary action taken will be specified. The likely consequences of further misconduct of failures will be indicated, along with the period of time given for improvement. A written warning will be deemed to have lapsed after six months, subject to continued satisfactory conduct and/or performance.
7.2 Final written warning: If, because of the seriousness of the offence, a written warning
would be inappropriate or, following enquiry/formal written warning, there is continued cause for concern, a disciplinary hearing will be convened on the same basis as before. You will be entitled to be accompanied by a colleague or trade union representative. A warning given after a hearing at this stage will be a final written warning. If there is no improvement [within a week], it may result in your dismissal. A final written warning will be deemed to have lapsed after one year, subject to continued satisfactory conduct and/or performance. It will include the identity of the partner to whom you may appeal under paragraph 7.7 below.
7.3 Dismissal: If, because of the seriousness of the offence a formal written warning is
inappropriate or there is no improvement, you may then be dismissed following a further hearing convened on the same basis as before. Your employer holds the power to dismiss you. A notice of dismissal will include the identity of the partner or partners to whom you may appeal under paragraph 7.7 below. Whether counselling or the issue of a formal written warning is appropriate depends entirely on the circumstances and severity of the alleged conduct. Therefore the stage of the procedure at which action is taken will depend on the seriousness of the offence.
7.4 Appeals: An appeal may always be made against a final written warning or dismissal.
Full written reasons for appeal must be submitted in writing within 14 days of the receipt of the warning or a letter informing you of your dismissal. A partner in the practice not
20
previously involved and the director of postgraduate general practice education will hear the appeal.
8. Training Numbers
“Gold Guide” procedures will be applied in the event that your training number is to be removed
21
Appendix 3
Grievance procedure 1 If you have any grievance relating to your employment, you should raise this initially with
the trainer/educational supervisor, or in the trainer/educational supervisor's absence the senior partner of the practice.
2 Minor grievances may be raised orally, though serious grievances must be in writing.
3 Any grievance meeting will be held as soon as possible and normally within one week of
the grievance being received. 4 If resolution is not possible, you or your trainer/educational supervisor may refer the
matter to [state name of an independent third party] or in appropriate cases to the director of postgraduate general practice education for an opinion.
Disputes relating to education and training may also be referred to the director of postgraduate general practice education if the LMC secretary/chief executive considers it appropriate, his agreement to such a referral should not be unreasonably withheld.
At stages 2 and 4 you may be accompanied by a friend, colleague or representative not acting in a legal capacity.
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Appendix 4 [State details of local educational agreement] *
SAMPLE
An educational agreement
between the trainer/educational supervisor, the practice and the
General Practice Specialty Trainee (adapted from a document by the Wessex deanery)
This agreement sets out the broad educational aims and objectives for the post of General Practice Specialty Trainee in this training practice and specifies the commitment required by the GPST and the trainer/educational supervisor to meet these objectives. It recognises that other members of the practice and its organisation are vital in the creation of the ideal learning environment, and so requires the signatures of another partner and the practice manager. The agreement aims to aid and enhance the educational process.
It is an agreement between <name of trainer/educational supervisor> in the <name of practice> and <name of GPST> for the period of general practice training from <date> to <date>.
The trainer/educational supervisor, the training practice and the GPST agree to:
(a) Produce an introductory pack containing information about the practice and the
first two weeks duties to be available before the GPST starts in the practice.
(b) Plan an introductory phase in practice (usually 2 – 4 weeks) to include opportunities (usually 2- 4 weeks) for sitting in with partners and exploring roles of other members of the primary health care team.
(c) Undertake a needs assessment to establish the GPST’s learning objectives.
This will be done using a variety of methods and sources. It will include knowledge, skills and attitudes, in clinical and non clinical domains.
(d) Produce an outline of a teaching plan (within two weeks) that starts to meet the
objectives defined in the needs assessment.
(e) Provide protected teaching time on a weekly basis for formal tutorials, the other learning and teaching opportunities in the practice, and day release course sessions. The GPST & trainer/educational supervisor are expected to prepare for and attend these sessions, which will be a minimum of two hours per week practice based teaching.
(f) Discuss specialist course requirements within the requirements of the RCGP
curriculum and their appropriate timing during the training period.
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(g) Plan assessments and examinations including summative assessment/or equivalent.
(h) Hold formative assessments and give feedback regularly with formal appraisal
sessions at appropriate intervals (at least three monthly) throughout the training period.
(i) Use assessment methods drawn from a wide range of sources, but to include
video recording of both consultations and tutorials throughout the training period.
(j) (GPST) Keep a record and log of her/his learning in the ePortfolio. This will
include learning objectives, the methods chosen to meet them, and the next review date.
(k) (Trainer/educational supervisor) Keep a record of all needs, assessments and
appraisals and document supporting evidence as required for the [ePortfolio/ general practice learning diary]* and a copy of signed, summative/or equivalent assessment trainer/educational supervisor’s report.
(l) Attend, on a regular and constructive basis, the VTS and trainer/educational
supervisor/GPR groups with only exceptional reasons accepted for non- attendance.
(m) Plan the requirements of day release/study leave/holidays. This should be
linked with the model contract.
(n) Evaluate the training year. This includes for the GPR an obligation to complete the GPR’s report in the last month of their training and send it to the LETB/Deanery.
(o) Use an appropriate GP education lead (e.g. course organiser/associate director)
to assist in reducing difficulties associated with the educational content of the training period.
This educational agreement has been agreed between two parties whose signature appears below:
Trainer/educational supervisor ...........................
GP Specialty Trainee ...........................................
Date of signing .....................................................
We the undersigned agree to give active support to Dr <name of trainer/educational supervisor> in the training of Dr <name of GPST>.
Partner ..................................................................
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Practice manager .................................................
[NB Two copies should be signed and held individually by GP trainer/educational supervisor and GP GPST.]
25
Appendix 5
December 2004 (revised Dec 2007
and February 2014)
GPC General Practitioners
Committee
Specimen: Handbook for
Committee of General Practice
Education
GP Specialty Trainees in general practice
Including notes for those drawing up a handbook
26
Contents Introduction for those drawing up the Handbook .................................................................................... 3
Specimen handbook of terms and conditions of service ......................................................................... 5
Introduction ............................................................................................................................................ 5
Part 1 ..................................................................................................................................................... 5
Part 2 .................................................................................................................................................. 18
Notes for those drawing up the handbook ........................................................................................... 27
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This specimen Handbook has been prepared to assist BMA members. The information and the views expressed in this publication are for further consideration and should not be acted upon without independent consideration and if necessary, professional advice. The BMA will not accept any responsibility for loss or other adverse consequences occasioned to any person acting or refraining from acting as a result of any material contained in this publication.
The Handbook and notes for those drawing it up apply to the situation in England and Wales. Similar conditions apply in Scotland and Northern Ireland but there are legislative and organisational differences. Members may obtain additional advice or clarification from First Point of Contact on 0300 123 1233 or by email to [email protected] . Please quote your current membership number. Members in the Channel Islands should contact the South West Centre and those in the Isle of Man, the North West Centre.
This document was drawn up by the BMA’s national medical and regional services group together with the General Practitioners’ Committee.
Although the specimen Handbook is BMA copyright, permission is granted to members to reproduce relevant sections for the production of an appropriate practice handbook.
Issued by:
British Medical Association
BMA House Tavistock Square London WC1H 9JP
www.bma.org.uk
This specimen Handbook has been produced to assist trainer/educational supervisors who employ GPSTs and GPST members themselves. It should be issued with the written contract of employment (see Introduction).
It is important to stress that each practice will have its own employment needs and contracts of employment. These must be assessed carefully before finalising the Handbook, taking particular account of any cross-referencing between the Handbook and the relevant contract. References in this handbook to a contract of employment are to the model produced by the BMA.
Please read the notes carefully before drawing up the Handbook.
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INTRODUCTION
The Handbook
1. This specimen gives an outline of what a handbook designed to underpin the contract of employment might contain but each paragraph must be considered carefully in the light of the circumstances of the practice. The Notes provide additional information for those drawing it up, and should be read in conjunction with the suggested paragraphs as indicated.
2. The Handbook is in two parts. The first part sets out details of rights and benefits
referred to in the contract of employment and the conditions attached to them. The second part sets out more general information which should be helpful to the GPST.
3. The Handbook should be issued to the GPST on appointment, with the written contract
of employment. A covering letter on practice headed notepaper should welcome the GPST to the practice and stress the importance of the contract and Handbook. An example of such a letter is given below.
Framework for a written contract 4. The Association produces a Framework for a written contract of employment: GPST in
general practice, to which this handbook is Appendix 5. The specimen Handbook assumes that the GPST will have a contract based on this Framework. Making a GPST’s appointment subject to a Handbook as set out in clause 2 of the Framework will render the Handbook contractually binding, where relevant, on both employer (the trainer/educational supervisor) and employee. The Framework is available from the BMA website or First Point of Contact whose staff can assist members with any additional enquiries.
Existing Staff
5. Members preparing a Handbook for the first time to be issued to an existing GPST may
need to adapt the specimen to tie in with contracts already in existence. Suggestions
6. The authors are happy to receive comments or suggestions about the specimen
Handbook for future editions. These can be made to your local BMA office. Induction
7. It is good practice to ensure that new members of staff have a planned programme of
induction. Time should be set aside for this in the first few days after commencement of duties, if not earlier. This should be arranged to enable them to be introduced to the practice team, particularly those with whom they will need to work closely. It should also aim to provide them with essential information regarding their new duties and surroundings.
29
8. The induction programme should be viewed as a continuing process through the following few weeks and/or months, in order to iron out any problems or difficulties quickly.
Specimen letter from the trainer/educational supervisor to the GPST
The Handbook should be issued to a new GPST at the same time as his/her contract – see Introduction (paragraph 3). Clearly, if you have prepared a Handbook for the first time to be issued to an existing GPST you will need to adapt this letter.
Dear….
I am glad to welcome you to the practice team.
Your Contract of employment is enclosed, together with our handbook for GP Specialty Trainees in general practice. The Handbook includes information that will assist you during the course of your employment. It should be read with the Contract of employment and forms part of the Contract.
My partners and I recognise that each member of our team plays an important part in providing the best possible service to our patients and this Handbook clarifies the standards we aim to achieve.
Please read both documents carefully before signing and dating your contract and returning it me. If you are concerned about any aspect of the documents please raise the matter with [state designated person] before signing.
[Induction – include reference to the practice’s programme of induction. See Introduction (paragraph 7/8].
We hope that you will enjoy working with us during this important period of your vocational training.
[signature] to be completed.
[Date]
Note for those drawing up the Handbook: [ ] indicates information that the GP Trainer/educational supervisor should complete.
A default suggestion is italicised.
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{ } draws attention to the Notes for GP Trainer/educational supervisors at the back of the specimen Handbook. These notes should not be included in the final version issued to the GPST.
31
SPECIMEN HANDBOOK FOR GP SPECIALTY TRAINEES IN GENERAL PRACTICE
Introduction Part 1 of this Handbook relates to the agreements set out in your contract of employment. Part 2 sets out some key policies of the Practice with which you are required to comply and also includes some more general information. It is intended to assist you in your day to day work. The information it contains will be reviewed from time to time and any suggested changes should be put to the [named GP Trainer/educational supervisor]* for consideration by the Partners.
If you are unsure about any terms and conditions of service in this Handbook you are advised to seek clarification and further explanation from your GP Trainer/educational supervisor not least because failure to observe them may result in disciplinary action.
Part 1
1 CONTRACT OF EMPLOYMENT
You will have received a contract of employment relating to your particular job enclosing this Handbook. When signed, these together form a legally binding agreement between yourself and your GP Trainer/educational supervisor. Any future changes in the terms and conditions of your employment will be confirmed in writing following agreement.
A timetable of duties is set out as Appendix 1 to your contract of employment. However, although you have been given a designated job title and specific duties, you may be asked to undertake other duties which are reasonably required of you. If this involves you in working extra hours, you will be paid at your current hourly rate.
2 ANNUAL LEAVE AND BANK HOLIDAYS (see note a)
Your entitlement to annual leave is set out in your contract of employment. The leave year runs from [ ] to [ ] and during the course of your appointment, you will be entitled to leave pro-rata to the annual amount for each completed month of service. Requests for annual leave should be submitted to [your GP Trainer/educational supervisor] at least six weeks in advance.
You are, in addition, entitled to eight Bank Holidays each year. If you are required to work on a Bank Holiday, you will be entitled to a day off in lieu.
Part-time staff are entitled to the same number of weeks annual leave (although for a smaller number of hours each week) and to Bank and Public holidays or days in lieu on a pro rata basis according to the number of hours you work compared with full time hours.
You will be entitled to carry-over a maximum of five days annual leave from one leave year to the next. Such carry-over is at the discretion of your GP Trainer/educational
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supervisor and you should raise this before the end of the leave year. 3 SICK LEAVE (see note b)
3.1 Notification of absence
If you are unable to work because of illness or injury, you must notify [your GP Trainer/educational supervisor] or the Practice Manager at the earliest practical opportunity. If your absence continues up to seven days, you will be required to submit a self-certificate to the Practice Manager. Absence beyond seven days must be covered by a certificate signed by another medical practitioner.
3.2 Payments during sickness
a In this paragraph, a month means a calendar month and a year means a
calendar year.
b Payments during sickness are made on the basis of:
Number of years of (continuous) service with the NHS; and
Number of months of sickness leave
in accordance with the table below
Years of service
1st year 1 month full pay and (after completing 4 months service), 2 months half pay
2nd year 2 months full pay and 2 months half pay
3rd year 4 months full pay and 4 months half pay
4th year 5 months full pay and 5 months half pay
5th year 5 months full pay and 5 months half pay
6th year + 6 months full pay and 6 months half pay
c Payments will be abated by the amount of any Statutory Sick Pay or
injury benefit which is payable.
d Where sickness absence totals more than two weeks, you may be required to extend your training up to the equivalent period to allow completion of training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
e The sick leave provisions in this paragraph shall apply from the date of
commencement of this contract and shall cease to apply on the termination of the contract for any reason; provided that, where you are in receipt of sick leave payments at the time of the termination of the contract, those payments shall be paid during your sickness, up to the limit of your maximum entitlement to payments, pursuant to the provisions in the table in sub-paragraph b.
33
f The rate of allowance and the period for which it is to be paid shall be ascertained by deducting from the period of benefit (under sub-paragraph b above) any days of paid sick leave during the twelve months immediately preceding the first day of absence. No reduction shall be made in respect of any absence resulting from any crime of violence connected to the GPST’s employment or profession.
3.3 Statutory Sick Pay
If you are sick you may also be entitled to Statutory Sick Pay (SSP) for up to twenty-eight weeks absence in any spell or series of linked spells of sickness. Spells separated by a period of eight weeks or less count as one. SSP will be supplemented so that during sickness you receive payment in accordance with the Practice sick pay scheme and when the time limits in the Practice scheme are exhausted, you will receive SSP only.
3.4 With prior approval of the [GP Trainer/educational supervisor] you will be allowed
reasonable paid time off to attend medical or dental appointments. Where necessary duties must be rearranged to provide adequate cover.
3.5 Sick pay is not a substitute for other leave to which you might be entitled (e.g.
dependent leave) unless you personally are ill and unable to work for that reason. SSP and contractual sick pay are not payable for compassionate or other forms of leave.
The Practice has a sickness absence management policy, which applies to all staff. You are required to abide by the notification of absence provisions (see above). You are also, when required by the Practice, obliged to attend Occupational Health or another nominated doctor in the event of sickness absence so that the Practice may obtain advice about your health situation.
3.6 Disabilities
If you believe you have a disability, you should inform [your GP Trainer/educational supervisor] and the Practice will discuss this with you in confidence. In the event that adjustments need to be considered to your working arrangements, we will strive to meet these if reasonably practicable and request that you ensure the Practice is kept up to date with your specific needs as time goes on. This forms part of the Practice’s Equal Opportunities Policy and we are also legally obliged to abide by the provisions of the Disability Discrimination Act (DDA) 1995.
4 DEPENDENT LEAVE (see note c)
4.1 Policy
The Practice policy is to apply the statutory provisions relating to dependent leave. This means that employees may take a reasonable amount of time off work to deal with certain unexpected or sudden emergencies and to make any
34
necessary longer term arrangements. Such leave will be without pay.
4.2 The circumstances under which time off can be taken under this right include:
If a dependent falls ill, or has been injured or assaulted
When a dependent is having a baby
To make longer term care arrangements for a dependent who is ill or
injured
To deal with a death of a dependent
To deal with an unexpected disruption or breakdown of care
arrangements for a dependent
To deal with an unexpected incident involving the employee’s child during school hours
The emergency must involve one of the employee’s dependants. A dependent is the husband, wife, child or parent of the employee. It also includes someone who lives in the same household as you. For example, this could be a partner or an elderly aunt or grandparent who lives in the household. It does not include tenants or boarders living in the family home, or someone who lives in the household as an employee, such as a live-in housekeeper.
In cases of illness or injury, or where care arrangements break down, a dependent may also be someone who reasonably relies on the employee for assistance. This may be where the employee is the primary carer or the only person who can help in an emergency, whether the employee lives with the person or not.
Employees are entitled to this right from day one of starting their job.
The right enables an employee to take action that is necessary to deal with an unexpected or sudden problem concerning a dependent and make any necessary longer term arrangements.
An employee is entitled to take a reasonable amount of time off.
The amount of time off that is reasonable will vary according to the circumstances of the emergency. For most cases, one or two days should be sufficient to deal with the problem. For example, if a child falls ill with chickenpox, the leave should be enough to help the employee cope with the crisis – to deal with the immediate care of the child, visiting the doctor if necessary, and to make longer term care arrangements. The employee is not entitled to take two weeks leave to look after a sick child. In the event of a dispute, you should seek to resolve the matter through the normal grievance procedures. No limit on the number of times an employee can be absent from work under this right has been set.
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4.3 Notification
You must tell [the GP Trainer/educational supervisor] as soon as practicable, the reason for the absence and how long you expect to be away from work. There may be exceptional circumstances where you return to work before it was possible to contact the employer, but you should still tell the Practice the reason for the absence on returning.
It is not necessary to give notice in writing.
5 PARENTAL LEAVE (see note c)
5.1 Policy
Parental leave is a right for parents to take time off work to look after a child or make arrangements for the child’s welfare. Parents can use it to spend more time with children and strike a better balance between their work and family commitments. The Practice policy is to apply the statutory provisions for parental leave.
5.2 Eligibility
Parental leave is available to employees who have, or expect to have, parental responsibility for a child. To be eligible, employees generally have to have one year’s continuous service with their current employer. However, special rules apply for parents of children born, or placed for adoption, before 14 December 1999. They will be eligible for parental leave from their current employer if they completed one year’s continuous service with another employer between 15 December 1998 and 9 January 2002.
5.3 Entitlement
Employees get thirteen weeks in total for each child. Parents of disabled children get eighteen weeks in total. For the purposes of parental leave a “disabled child” is one for whom an award of Disability Living Allowance has been made.
An employee can take leave in blocks of one week or more (for example, in two- week or three-week blocks), up to a maximum of four weeks in a year for each child, unless the Practice agrees to vary this at their discretion. Parents whose child is entitled to Disability Living Allowance can take the leave in days or periods shorter than a week.
5.4 Notification
An employee needs to give at least twenty-one days notice to his or her employer, giving the dates when the leave is to start and finish. The notice does not have to be in writing.
5.5 If the Practice considers that an employee’s absence would unduly disrupt the
business, then the Practice can postpone the leave for no longer than six months after the beginning of the period that the employee originally wanted to start his
36
or her parental leave. The Practice will discuss the postponement with the employee and give notice of the postponement in writing no later than seven days after the employee’s notice to take leave was given to him. Notice from the Practice should state the reason for the postponement and set out the new dates of parental leave. The length of the leave should be equivalent to that in the employee’s original request. Leave may only be postponed where the Practice considers that the business would be unduly disrupted if the employee took leave at the time he or she has chosen. The Practice may be justified in postponing leave when, for example, the work is at a seasonal peak; where a significant proportion of the workforce applies for parental leave at the same time; or when the employee’s role is such that his or her absence at a particular time would unduly harm the business.
In the case of GPSTs such circumstances are unlikely. However, the Practice will wish to discuss the impact of any such absence on the training if it is felt that this would be detrimental to the traineeship e.g. proximity to summative, or equivalent, assessment, etc. Approval for such leave will not be unreasonably withheld.
You may be required to extend your training period to complete your training. The decision, in regard to the length of further training required, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
When an employee applies to take parental leave immediately after the birth or adoption of a child, then the employer cannot postpone the leave. The employee needs to give twenty-one days notice before the beginning of the expected week of childbirth (expectant mothers will be able to provide this information to their partners). In the case of adoption, the employee needs to give twenty-one days notice of the expected week of placement. In rare cases where this is not possible, an adoptive parent should give the notice as soon as is reasonably practicable. Provided that the employee has given the notice set out above, parental leave will start on the day on which the child is born, regardless or whether the child is born early or late, or placed for adoption. Women who have given birth are entitled to maternity leave after the birth of their child, so whether they are able to take parental leave immediately after maternity leave would be subject to the normal arrangements for postponement and would depend on whether their absence would unduly disrupt the business.
5.6 The Practice is free to request records from a previous employer, even though
the previous employer is not required to have kept them or supply them. For parents of children born or adopted between 15 December 1994 and 14 December 1999, employers are free to request evidence of an employee’s previous service from an employer, where the period of service with that employer is being counted as qualifying service when determining the employee’s eligibility for parental leave.
6 ADOPTION LEAVE (see also paternity leave below in relation to adoption) (see note c)
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6.1 Policy
The Practice policy is to apply the statutory provisions for adoption leave. Full details are available from the Practice Manager but the main elements are as follows.
6.2 Eligibility
To qualify for adoption leave, an employee must:
Be *newly matched with a child for adoption by an adoption agency.
Have worked continuously for the Practice for twenty-six weeks ending with the week in which they are notified of being matched with a child for adoption.
* Adoption leave and pay is not available in circumstances where a child is not newly matched for adoption, for example when a step-parent is adopting a partner’s children.
Adopters are entitled to up to twenty-six weeks ordinary adoption leave followed immediately by up to twenty-six weeks additional adoption leave – a total of up to fifty-two weeks leave.
Ordinary adoption leave is normally paid (see 6.3 below)
Additional adoption leave is unpaid.
Employees can choose to start their leave:
From the date of the child’s placement (whether this is earlier or later than
expected), or
From a fixed date which can be up to fourteen days before the expected date of placement.
Leave can start on any day of the week
Only one period of leave is available irrespective or whether more than one child is placed for adoption as part of the same arrangement.
If the child’s placement ends during the adoption leave period, the adopter can continue adoption leave for up to eight weeks after the end of the placement.
6.3 Statutory Adoption Pay
During their adoption leave, most adopters are entitled to Statutory Adoption Pay (SAP) from their employers. Statutory Adoption Pay is paid by employers for up to twenty-six weeks. The rate of Statutory Adoption Pay is the same as the standard rate of Statutory Maternity Pay.
Adopters who have average weekly earnings below the Lower Earnings Limit for
38
National Insurance contributions do not qualify for Statutory Adoption Pay. They should contact their adoption agency as they may be able to receive financial support in relation to their adoption payment. Additional financial support may be available through Housing Benefit, Council Tax Benefit or Tax Credits. Further information is available from your local Job Centre Plus office of Social Security office.
6.4 Notice of Intention to Take Adoption Leave
Adopters are required to inform their employers of their intention to take adoption leave within seven days of being notified by their adoption agency that they have been matched with a child for adoption, unless this is not reasonably practicable. They need to tell their employers:
When a child is expected to be placed with them and
When they want their adoption leave to start.
Adopters can change their mind about the date on which they want their leave to start providing they tell their employer at least twenty-eight days in advance (unless this is not reasonably practicable). They must tell their employer the date they expect any payment of Statutory Adoption Pay to start at least twenty-eight days in advance, unless this is not reasonably practicable.
The Practice has twenty-eight days in which to respond to their employee’s notification of their leave plans. An employer must write to the employee, setting out the date on which they expect the employee to return to work if the full entitlement to adoption leave is taken.
6.5 Matching Certificate
Employees must give their employer documentary evidence – from their adoption agency – as evidence of their entitlement to Statutory Adoption Pay. The Practice can also ask for this as evidence of entitlement for adoption leave. Employees should ask their adoption agency for this documentary evidence, which may be provided in the form of a matching certificate, which includes basic information on matching, and expected placement dates.
6.6 Contractual Benefits
Employees are entitled to the benefit of their normal terms and conditions of employment, except for terms relating to wages or salary throughout their twenty- six weeks ordinary adoption leave period. However, most adopters are entitled to Statutory Adoption Pay during this period.
During additional adoption leave, the employment contract continues and some contractual benefits and obligations remain in force, for example compensation in the event of redundancy and notice periods.
39
6.7 Return to Work after Adoption Leave
Adopters who intend to return to work at the end of their full adoption leave entitlement do not have to give any further notification to their employers.
Adopters who want to return to work before the end of their adoption leave period must give their employers twenty-eight days notice of the date they intend to return.
You may be required to extend your training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
6.8 Protection from Detriment and Dismissal
Employees are protected from suffering detriment or unfair dismissal for reasons related to taking, or seeking to take, adoption leave. Employees who believe they have been treated unfairly can complain to an Employment Tribunal.
7 MATERNITY LEAVE POLICY (see notes d and k)
7.1 Introduction
GPSTs are entitled to maternity leave and pay in accordance with the Schedules to Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent) as amended and the statutory entitlements contained in the Employment Act 2002, Employment Rights Act 1996 and associated regulations. The provisions are similar to those contained within the Hospital Medical and Dental Terms and Conditions of Service The full provisions can be seen in the Practice Manager’s office but the main principles are as follows:
7.2 Maternity Leave Eligibility – Conditions
All employed GPSTs who give birth are entitled to take up to fifty-two weeks’ maternity leave made up of 26 weeks’ ordinary maternity leave (“OML”) and up to 26 weeks’ additional maternity leave (“AML”) immediately following OML.
Maternity leave will commence upon the earlier of:
7.2.1 The date notified to the employer as the date upon which the GPST intends to
commence her maternity leave (or, if varied in accordance with paragraph 7.5.4 below, the last date notified to the employer, which must be on or after the beginning of the eleventh week before the expected week of childbirth; or
7.2.2 The day which follows the first day upon which the GP Trainee is absent from
work wholly or partly due to her pregnancy (or childbirth) after the beginning of
40
the fourth week before the expected week of childbirth; or
7.2.3 The day which follows the birth of a GPST‘s child.
Maternity leave will continue until the end of fifty-two weeks after the beginning of her maternity leave. She may return to work before the end of her full maternity leave entitlement provided that she complies with the notification requirements at paragraph 7.9.2 below. Please note however that a GPST will not be permitted in any circumstances to work during the 2 weeks immediately following the birth of her child.
7.3 Maternity Pay and Benefits
GPSTs are entitled to benefit from all of their terms and conditions of employment throughout their OML and AML periods (subject to the relevant rules from time to time in force), except for wages or salary. Wages or salary includes cash benefits and some non-cash benefits which are provided for Practice use only. For further details about specific benefits, please contact the Practice Manager.
The employer’s maternity pay scheme follows the current statutory rates for Statutory Maternity Pay (“SMP”), if payable, but the employer will also grant GPSTs Occupational Maternity Pay, above the normal SMP rates, if they satisfy all of the additional eligibility criteria as set out at paragraph 7.4 below and the notification requirements at paragraph 7.5 below.
Those GPSTs who do not meet the eligibility criteria at 7.4 should be entitled to receive Statutory Maternity Pay for 39 consecutive weeks if they fulfil the notification requirements at paragraph 7.5 below and all of the following conditions:
7.3.1 Have 26 weeks’ continuous employment with the GP Trainer/educational
supervisor by the beginning of the fourteenth week before the expected week of childbirth;
7.3.2 Have qualifying average weekly earnings;
7.3.3 Are still pregnant 11 weeks before the expected week of childbirth or have already given birth;
7.3.4 Have given the employer at least 28 days’ notice, or if not reasonably practicable, as soon as is reasonably practicable, notice of the date she intends SMP to start; and
7.3.5 Have supplied evidence to the employer confirming the date of the expected week of childbirth (usually from a doctor or midwife in the form of a MATB1).
The rate of SMP is subject to an annual review by the Government – please contact the Practice Manager to find out current rates of SMP.
GPSTs that do not qualify for SMP may be entitled to Maternity Allowance. via Jobcentre Plus.
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7.4 Occupational Maternity Pay Eligibility Requirements - Conditions
7.4.1 To be eligible to receive Occupational Maternity Pay the GPST must have complied with paragraphs 7.4.2, 7.4.3 and 7.4.4 below.
7.4.2 The GPST must have completed at least twelve months continuous
service which may be with one or more employing authority or local authority or as a GPST in General Practice immediately before the beginning of the eleventh week before the expected week of childbirth. In this paragraph, “employing authority” means a Health Authority, a Primary Care Organisation, a Strategic Health Authority or an NHS Trust. A break in service will not be considered as breaking the twelve months continuous service and may for this purpose be disregarded if it is:
7.4.2.1 Three calendar months or less between termination of
employment with one Strategic Health Authority and resumption with another,
7.4.2.2 Three calendar months or less between GPST posts,
7.4.2.3 Or less than six calendar months spent in employment of a person providing primary medical services to the National Health Service pursuant to a general medical services contract, a personal medical services agreement or an alternative provider medical services contract (under section 16cc(2) of the National Health Service 1977) or
7.4.2.4 A period of up to six months spent abroad as part of an approved vocational training programme on the advice of a Postgraduate Dean or College or Faculty Adviser in the specialty concerned, and
7.4.3 The GPST must continue to be employed until immediately before the
beginning of the eleventh week before the expected week of childbirth.
7.4.4 The GPST must notify her GP Trainer/educational supervisor, in writing, of her intention to resume the traineeship with the same or another GP Trainer/educational supervisor after her childbirth; and this notification should be made not later than 21 days before the maternity leave commencement date or, if this is not possible, as soon as is reasonably practicable.
7.4.5 If in addition to the notification requirements at paragraph 7.5 below 7.4.2,
7.4.3 and 7.4.4 above are satisfied then payments during maternity leave will be on the following basis:
7.4.5.1 If the GPST intends to return to the GP training scheme or the
NHS she is entitled to
7.4.5.1.1 Full pay for the first eight weeks of absence less Statutory
Maternity Pay or Statutory Maternity Allowance.
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7.4.5.1.2 For the next 10 weeks of absence half of full pay, reduced only to the extent that half of full pay and Statutory Maternity Pay or National Insurance benefits receivable or 'notional equivalent' exceed full pay
7.4.5.1.3 The statutory pay provisions provide for further payments
from the twenty-sixth to thirty-ninth week of maternity leave based on the Statutory Maternity Pay limit.
7.4.5.2 In the case of a part-time GPST “full pay” means the amount
earned by the GPST for the hours she normally works.
7.4.6 Where a GPST qualifies for maternity leave but does not intend to resume her traineeship with the same or another GP Trainer/educational supervisor, the payments will be the equivalent of six weeks pay at nine- tenths full pay, less any SMP or SMA of which the GPST is entitled to and then Statutory Maternity Pay or Statutory Maternity Allowance alone for the remaining thirty-three weeks of paid leave. Further conditions may apply, please consult your employer for more details.
7.4.7 For details of how ‘full pay’ shall be calculated speak to your GP
Trainer/educational supervisor.
7.4.8 In order that the Practice might continue to receive payments of the GPST’s allowance during any maternity leave taken, the GP Trainer/educational supervisor and the GPST may be required to confirm that the arrangements made have been in accordance with these conditions and therefore it is important that all the necessary information and documentation is provided in good time and in line with the above provisions..
7.5 Notification Requirements
7.5.1 The GPST must:
7.5.1.1 Notify the employer, in writing, of the fact that she is pregnant, her expected week of childbirth, her intention to take maternity leave and the date she intends to commence maternity leave; She must notify her employer by the end of the fifteenth week before the expected week of childbirth or, if that is not possible, as soon as is reasonably practicable thereafter,
7.5.1.2 Submit to the GP Trainer/educational supervisor a statement from a registered medical practitioner, or a certified midwife, indicating the expected date of childbirth (Form MATB1) as soon as possible and in any event, not later than 21 days before the commencement of maternity leave or, if this is not possible, as soon as is reasonably practicable
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7.5.1.3 Confirm the date she wants her Statutory Maternity Leave to start. This should be done as soon as possible; and
7.5.1.4 Provide written confirmation of the actual date of childbirth once it has taken place
7.5.2 The GP Trainer/educational supervisor will send a written request not earlier than
49 days from the date on which he or she was notified as the beginning of the expected week of childbirth or the date of childbirth to the GPST asking her to confirm in writing that she intends to resume her traineeship and the GPST should give the written confirmation asked for within fourteen days of receiving the request, or if that is not reasonably practicable, as soon after as is reasonably practicable.
7.5.3 Within 28 days of receiving the written notification at 7.5.1.1 or 7.6 or 7.7 below or, if the GPST has varied the start of her maternity leave in accordance with 7.5.4 below, within 28 days of the start of the GPST’s maternity leave, the GP Trainer/educational supervisor will write to the GPST to confirm her expected return date assuming she takes her full maternity leave.
7.6 Absence
If the GPST is absent from work wholly or partly by reason of pregnancy after the beginning of the 4th week before the expected week of childbirth, she must give written notice of this and of the date on which this absence began to the employer as soon as is reasonably practicable. The GPST’s maternity leave will start on the day after this absence started.
Absence prior to the last four weeks before the expected week of childbirth, supported by a medical statement of incapacity for work, or a self-certificate, shall be treated as sick leave in accordance with normal sick leave provisions.
7.7 Premature Birth
If the GPST’s baby is born before she starts her maternity leave, she must give written notice of this and of the date of the birth to the GP Trainer/educational supervisor as soon as is reasonably practicable. The GPST’s maternity leave will start on the day following the date of the birth.
A GPST whose childbirth has occurred prior to the eleventh week before the expected week of childbirth may, with the agreement of her GP Trainer/educational supervisor, spread her maternity leave entitlement, taking a minimum period of two weeks’ leave immediately after childbirth and then returning to work to continue her leave following the child’s discharge from hospital. GPSTs should consult their employer to discuss
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how their entitlement to SMP and maternity leave may be affected by this arrangement.
7.8 Annual Leave
During maternity leave annual leave will accrue at the rate provided under the GPST’s contract. If the holiday year is due to end during the GPST’s maternity leave, she should ensure that she has taken the full year’s entitlement before starting her maternity leave, with the exception of up to 5 days which can be carried over to the next leave year with the prior agreement of her GP Trainer/educational supervisor. This is at the GP Trainer/educational supervisor’s discretion.
7.9 Return to work
The GPST should inform her GP Trainer of the date she proposes to return, in writing, at least 21 days before that date;
7.9.2 If the GPST wishes to return to work before her expected return date, she should
inform her GP Trainer/educational supervisor of the date she proposes to return, in writing, at least 21 days before the date on which she intends to return. Even if the GPST intends to return on completion of her full maternity leave entitlement, it would be helpful if she could confirm the date she intends to return as early as possible.
7.9.3 If the GPST attempts to return to work earlier than the end of her full maternity
leave entitlement without giving eight weeks’ notice of her return, the GP Trainer/educational supervisor can postpone the GPST’s return to a date that will ensure the Practice will have eight weeks’ notice of her return (“the Postponed Date”). However, this date will not be a date after the end of the GPST’s full maternity leave entitlement.
7.9.4 If the GPST does not intend to return to work, or is unsure, it is helpful if she
discusses this with the GP Trainer/educational supervisor as early as possible. If she decides not to return, she should give notice of resignation in accordance with her contract. The amount of maternity leave left to run when she gives notice must be at least equal to her contractual notice period; otherwise the Practice may require her to return to work for the remainder of the notice period. Once she has given notice that she will not be returning to work, she cannot change her mind without the GP Trainer/educational supervisor’s agreement. If the GPST does not return to work, any maternity pay received will have to be returned, excluding SMP which the GPST is entitled to regardless of intention to return to work.
7.95 If the GP Trainer/educational supervisor has reasonable doubts whether the GPST is medically fit to return to duty after childbirth, her return should be delayed until the GPST produces a doctors’ statement of fitness for duty.
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7.10 Keeping in Touch
7.10.1 Shortly before the GPST’s maternity leave is due to start, her GP Trainer/educational supervisor may discuss the arrangements for covering the GPST’s work and the opportunities to remain in contact, should she wish to do so, during her maternity leave.
7.10.2 The GP Trainer/educational supervisor may make reasonable contact with the
GPST from time to time during her maternity leave.
7.10.3 The GPST may work (including attending training) for up to 10 days during maternity leave without bringing her maternity leave or Statutory Maternity Pay to an end. The arrangements, including pay, would be set by agreement. The GPST is not obliged to undertake any such work during maternity leave and the Practice are not obliged to provide it. In any case, the GPST must not work in the 2 weeks following the birth.
7.11 Extension of Traineeship During Maternity Leave
Where a GPST’s contract is due to expire after the eleventh week before the expected childbirth, her contract will be extended for any period up to 52 weeks to allow her to receive the full twenty-six weeks of Occupational Maternity Pay, if payable. She will also be entitled to receive the remaining thirteen weeks of Statutory Maternity Pay thereafter, if payable.
The GPST will also be required to extend her training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with her GP Trainer/educational supervisor.
7.12 Time Off for Ante-Natal Care
A GPST will be entitled to reasonable time off work to receive ante-natal care provided that she has an appointment at an ante-natal clinic on the advice of a doctor, a midwife, or a health visitor and if requested by the Practice or GP Trainer/educational supervisor she must be able to produce an appointment card (except for the first appointment).
The GPST should try to give the Practice or GP Trainer/educational supervisor as much notice as possible of the appointment.
7.13 Incremental Dates
Absence on maternity leave, whether paid or unpaid, shall count towards any incremental progression to which the GPST may be entitled, and will not defer the original incremental date.
7.14 Health and Safety
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Certain statutory regulations may prevent a GPST from carrying out her duties whilst she is pregnant, if she has recently given birth or is breast-feeding. A GPST may therefore: be asked to change her working conditions or hours of work; be offered suitable alternative work on terms and conditions that are the same or not substantially less favourable; or be suspended on full pay at any time either during her pregnancy or on her return to work, where there is no suitable alternative work. If there is suitable alternative work, which the GPST unreasonably refuses, she will not be paid.
If a GPST has any concerns about her own health and safety at any time, she should speak to her GP Trainer/educational supervisor immediately.
7.15 Statutory Rights
Nothing in these arrangements for maternity leave shall be interpreted as qualifying a GPST’s statutory maternity rights. GPSTs may wish to refer to the DWP web pages linked below which provide specific details of statutory entitlements.
www.dwp.gov.uk/publications/specialist-guides/technical-guidance/ni17a-a-guide-to- maternity
7.16 Ancillary Rights
Please be aware that a GPST’s spouse, civil partner or partner may be entitled to benefit from paternity leave. This may affect how the GPST decides to exercise her rights under this Policy.
8 PATERNITY LEAVE (including that relating to adoption) (see note c)
8.1 Policy
The Practice policy is to apply the statutory provisions for paternity leave. Full details are available from the Practice Manager but the main elements are as follows.
8.2 Certain employees can take paternity leave in relation to the birth or adoption of a child. However, in adoption cases, paternity leave will not be available to an employee who has decided to take adoption leave.
8.3 Ordinary Paternity Leave
In order to qualify for Ordinary Paternity Leave, employees must comply with all of the following conditions:
8.3.1 Have been continuously employed by the Practice for at least twenty-six weeks
ending with the week immediately before the 14th week before the expected week of the baby’s birth or the week in which the adopter is notified of having been matched with a child;
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8.3.2 Be the biological father of the child or the mother’s husband, civil partner or partner or be the adopter’s spouse, civil partner or partner.- (i.e. you live with the mother/adopter in an enduring family relationship)
8.3.3 Have or expect to have, if you are the child’s biological father, responsibility for the upbringing of the child, or, if not the child’s biological father, main responsibility (with the child’s mother or adopter) for the child’s upbringing; and
8.3.4 Be taking leave for the purpose of caring for a child or supporting a child’s mother
or adopter.
Employers can ask their employees to provide a signed declaration as evidence that they meet these eligibility conditions.
8.4 Length of Ordinary Paternity Leave
Eligible employees can choose to take either one week or two consecutive weeks’ Ordinary Paternity Leave (not odd days or instalments).
In the case of a child’s birth, Ordinary Paternity Leave can start on any day of the week, but must be completed within 56 days of the actual birth (or, if the child is premature, within 56 days from the first day of the expected week of childbirth). Employees can choose to start their leave either:
8.4.1 From the date of the child’s birth (whether this is earlier or later than expected), or
8.4.2 From a chosen number of days or weeks after the date of the child’s birth
(whether this is earlier or later than expected), or
8.4.3 From a predetermined date later than the first day of the week in which the baby
is expected to be born.
Only one period of Ordinary Paternity Leave and/or Additional Paternity Leave (“APL”) is available to employees irrespective of whether more than one child is born as the result of the same pregnancy.
In the case of adoption, Ordinary Paternity Leave can start on any day of the week on or following the date the child is placed with the adopter, but must be completed within 56 days of the child’s placement. Employees can choose to start their leave:
8.4.4 From the date of the child’s placement (whether this is earlier or later than
expected), or
8.4.5 From a chosen number of days or weeks after the date of the child’s placement (whether this is earlier or later than expected), or
8.4.6 From a predetermined date which is later than the date on which the child is
expected to be placed with the adopter.
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Only one period of Ordinary Paternity Leave and/or APL is available to employees irrespective of whether more than one child is placed as part of the same arrangement
8.5 Additional Paternity Leave
If your baby’s expected week of birth begins, or you are notified of having been matched for adoption, you are entitled to APL if, in addition to the conditions at 8.3.1 to 8.3.4 above:
8.5.1 You remain employed by the Practice until the week before the first week of your
APL;
8.5.2 The child’s mother or the co-adopter has been entitled to:
8.5.2.1 In birth cases, maternity leave, statutory maternity pay or maternity allowance in respect of her pregnancy; or
8.5.2.2 In adoption cases, one or both of adoption leave or statutory adoption pay in
respect of the child’s adoption and you have been matched with the child for adoption; and
8.5.3 The child’s mother or your co-adopter has, or is treated as having, returned to
work.
8.6 Length of Additional Paternity Leave
APL must be taken in a single block of complete weeks. The minimum amount of APL that can be taken is 2 weeks and the maximum is 26 weeks. APL must be taken in the period beginning 20 weeks after the child’s date of birth, or the date the adoption was finalised, and ending 12 months after the date of birth or the date of adoption placement.
8.7 Paternity Pay
If an employee has 12 months’ continuous service, following the same definition of continuous service as applies to maternity leave, they will qualify for two weeks full allowance less any statutory paternity pay receivable.
8.8 Statutory Paternity Pay
Where an employee does not have 12 months continuous service, but meets the qualifying criteria for Ordinary Paternity Leave set out above, they will be entitled to receive up to two weeks Ordinary Statutory Paternity Pay (OSPP), if they meet the statutory eligibility criteria.
OSPP is paid by employers for either one or two consecutive weeks as the employee has chosen. The rate of OSPP is the same as the standard rate of Statutory Maternity Pay. Employees who have average weekly earnings below the Lower Earnings Limit for
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National Insurance purposes do not qualify for OSPP. Employees who do not qualify for OSPP, or who are normally low paid, may be able to get Income Support while on paternity leave. Additional financial support may be available through Housing Benefit, Council Tax Benefit, Tax Credits or a Sure Start Maternity Grant.
Employees must tell their employer the date they expect any payment of OSPP to start at least 28 days in advance, unless this is not reasonably practicable.
If you take APL in accordance with this policy, you may be entitled to Additional Statutory Paternity Pay (ASPP). Whether you are and, if so, for how long you may be entitled to ASPP will depend on:
8.8.1 Your average earnings (during the 8 week period ending before the 14th week before the expected week of childbirth) being at or above the Lower Earnings Limit set by the Government; and
8.8.2 The Child’s mother, or your co-adopter, having returned to work without having taken at least 2 weeks of their statutory maternity allowance, maternity pay or statutory adoption pay. Your entitlement to ASPP will equate to the number of weeks of unexpired maternity allowance, statutory maternity pay or statutory adoption pay that remained when the child’s mother or your co-adopter returned to work.
The amount of ASPP paid will be based on statutory rates currently in force which may be the lesser of the current flat weekly rate set by the Government each year or 90% of
your average weekly earnings during the 8 week period ending before the 14th week before the expected week of childbirth.
8.9 Notice of Intention to Take Ordinary Paternity Leave
In the case of a child’s birth, employees must inform their employer of their intention to take Ordinary Paternity Leave in or before the fifteenth week before the expected week of the baby’s birth or, if this is not possible, then as soon as is reasonably practicable. They must tell their employer in writing;
8.9.1 The week the baby is due;
8.9.2 Whether they wish to take one or two consecutive week’s leave; and
8.9.3 When they want their leave to start.
In the case of adoption, employees must inform their employer of their intention to take Ordinary Paternity Leave within seven days of the adopter being notified by their adoption agency that they have been matched with a child or, if this is not possible, then as soon as is reasonably practicable. They must tell their employer in writing:
8.9.4 The date on which the adopter was notified of having been matched with the child;
8.9.5 When the child is expected to be placed;
8.9.6 Whether they wish to take one or two consecutive weeks’ leave; and
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8.9.7 When they want their leave to start.
Employees can change their mind about the date on which they want their Ordinary Paternity Leave to start, providing they give written notice to their employer at least twenty-eight days in advance (or, if this is not possible, then as soon as is reasonably practicable.)
Employees must also give a further notice as soon as reasonably practicable after the child’s birth, or placement for adoption, of the date of birth or placement.
8.10 Notice of Intention to Take Additional Paternity Leave
If you intend to take APL in relation to the birth of a baby, you must provide your employer with the following at least 8 weeks before the date on which you would like the APL to start;
8.10.1 A written “leave notice” stating;
8.10.1.1 The expected week of childbirth;
8.10.1.2 The approximate dates on which you would like you APL to start and finish;
8.10.2 A signed “employee declaration” confirming that;
8.10.2.1 The purpose of the period of leave will be to care for the child
8.10.2.2 You are either the child’s father or that you are the child’s mother’s spouse, civil partner or partner; and
8.10.2.3 Apart from the child’s mother, you have or you expect to have the main responsibility for the upbringing of the child; and
8.10.3 A written “mother’s declaration” from the child’s mother stating:
8.10.3.1 Her name, address, and National Insurance number
8.10.3.2 The date she intend to return to work;
8.10.3.3 You are either the child’s father or that you are the child’s mother’s spouse, civil partner or partner;
8.10.3.4 That to her knowledge you are the only person exercising the entitlement to APL in respect of the child; and
8.10.3.5 That she consents to the employer processing the information she has provided.
Your employer will write to you to confirm the start and finish dates of your APL within 28 days of receiving this leave notice. The employer may
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require you to provide a copy of the child’s birth certificate and the name and address of the mother’s employer, or if she is self-employed, her business address.
If you intend to take APL following a child’s adoption, you must provide your employer with the following at least 8 weeks before the date on which you would like your APL to start;
8.10.4 A written “leave notice” stating;
8.10.4.1 The date on which you were notified that you have been matched with the child;
8.10.4.2 The expected date on which the child is to be placed with you; and
8.10.4.3 The approximate dates on which you would like your APL to start and finish;
8.10.5 A signed “employee declaration” confirming that:
8.10.5.1 The purpose of the period of leave will be to care for the child;
8.10.5.2 You are either the spouse, partner, or civil partner of the child’s co-adopter; and
8.10.5.3 You have been matched with the child for adoption: and
8.10.6 A written “adopter declaration” from the child’s co-adopter stating:
8.10.6.1 Their name, address, and National Insurance number;
8.10.6.2 The date they intend to return to work;
8.10.6.3 That you are their spouse, partner or civil partner; and
8.10.6.4 That they consent to the employer processing the information they have provided.
Your employer will write to you to confirm the start and finish dates of your APL within 28 days of receiving this leave notice. The employer may require you to provide the name and address of the co-adopter’s employer (or if he/she is self-employed, his/her business address) and documentary evidence issued by the adoption agency which confirms the name and address of the agency and the date on which you were notified that you had been matched with the child and the date on which the agency expected to place the child with you.
In the case of birth of adoption, employees can change their mind about the date on which they want their APL to start, providing they give written notice to their employer at least 6 weeks in advance of the original start
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date, at least 6 weeks before the new date. In any case, if this is not possible, as soon as is reasonably practicable and, in these circumstances, if the employer is entitled to require you to take a period of APL of up to 6 weeks starting on either the original date or the revised date.
8.11 Self-Certificate
Employees must give their employer a completed self-certificate as evidence of their entitlement to OSPP and ASPP The self-certificate must include a declaration that the employee meets certain eligibility conditions and provide the information specified above as part of the notice requirements. Employers will not be expected to carry out any further checks.
8.12 Contractual Benefits
Employees are entitled to the benefit of their normal terms and conditions of employment, except for terms relating to wages or salary, throughout their Ordinary Paternity Leave and APL. However, most employees will be entitled to OSSP for Ordinary Paternity Leave and may be entitled to ASPP for some of the APL period.
During Ordinary Paternity Leave and APL employees’ annual leave will accrue at the rate provided for under their contract.
8.13 Keeping in Touch During Additional Paternity Leave
Your employer may make reasonable contact with you from time to time during your APL.
You may work (including attending training) for up to ten days during APL without bringing your Ordinary Paternity Leave or APL to an end.
8.14 Return to Work after Paternity Leave
Employees are normally entitled to return to the same job following Ordinary Paternity Leave or APL, However, if you have combined your Ordinary Paternity Leave or APL with a period of additional maternity leave, additional adoption leave or parental leave of more than 4 weeks, and it is not reasonably practicable for you to return to the same job, the employer will endeavour to offer you a suitable and appropriate alternative position.
You may be required to extend your training period to complete training. The decision, in regard to the length of further training, will be made by the Director of Postgraduate GP Education after consultation with your trainer/educational supervisor.
If you wish to return early from APL, you must give the employer at least 6 weeks’ prior notice. You must return to work at the end of your paternity leave. If you cannot because you are ill then you should follow the normal procedure for sickness absence.
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8.15 Protection from Detriment and Dismissal
Employees are protected from suffering unfair treatment or dismissal for taking, or seeking to take, Ordinary Paternity Leave or APL. Employees who believe they have been treated unfairly can complain to an Employment Tribunal.
9 TIME OFF FOR OTHER PURPOSES
You are entitled to reasonable time off work [with/without pay] for certain public duties including attendance at meetings of local authorities, health authorities and school governing bodies. Full details are available from the Practice Manager and at the discretion of your employer to whom requests should be made.
Leave for any other purpose may, exceptionally, be granted at the discretion of your employer and normally only where your entitlements to other leave have been exhausted.
10 TRAINING AND STUDY LEAVE
Details of your study leave provisions are noted in paragraph 20.3 of the accompanying contract of employment.
If study leave is granted, you will be paid as normal. Responsibility for any course fees, travelling and subsistence expenses will be determined by the LETB/Deanery or equivalent body on each occasion study leave is requested. The LETB/Deanery or equivalent body will not, however, accept responsibility for examination fees.
Requests for study leave and reimbursement of associated expenses (if any) should be made to your employer.
All such training and study leave is undertaken at your employer’s discretion (although this may be in discussion with your Vocational Scheme Course Organiser), unless undertaken in your own time and at your own expense.
All staff will be required to participate in relevant training programmes organised within the Practice. Where these are held outside your normally contracted hours, you will be paid at your normal rate or given time off in lieu.
11 MOTOR CARS AND EXPENSES (see note e)
Your contract requires you to provide a suitable motor vehicle for use in connection with your duties. You will be entitled to a motor vehicle allowance at rates in accordance with the Schedules to Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent) as amended from time to time.
If entitled to under the Directions, any claims for mileage reimbursement must be submitted promptly and regularly on the form that is available from the Practice Manager.
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You must ensure that your insurance policy covers you personally to use the vehicle for business purposes.
12 LEAVING EMPLOYMENT
If you wish to terminate your employment you must give notice of your intention to leave according to the period specified in your contract of employment. Outstanding wages or salary will either be paid when you leave or forwarded subsequently within a month, together with your P45 income tax form.
Any leave entitlement owing to you may be taken either before you leave or be paid on leaving. Leave that has been taken in excess of entitlement at the date of termination of employment will be deducted from your final salary or wage.
13 OUTSIDE ACTIVITIES
Subject to the provisions of clause 14 of your contract of employment, you must not, without the prior written consent of the GP Trainer/educational supervisor, accept any other employment outside the Practice. Consent will not be unreasonably withheld. Any such employment must not impinge on your contracted duties or your education as determined by the GP Trainer/educational supervisor. You hereby agree to permit your GP Trainer/educational supervisor to approach any other company, firm or person whom you are, or may be, employed for the purposes of ascertaining the extent of outside activities. The GP Trainer/educational supervisor’s consent to your accepting outside employment does not imply any responsibility on his or the Partners’ part for your acts and omissions in the course of such activities.
14 TRADE UNION MEMBERSHIP
You are free to become a member of a Trade Union. However, it is not a condition of employment that you do so. You will not be discriminated against in any way as a result of your membership or non-membership of a Trade Union.
15 EQUALITY OF OPPORTUNITY (see note f)
The Practice has an equal opportunities policy which strives to ensure that all staff are treated equally with dignity and respect. The policy can be seen in the Practice Manager’s office. We require all staff to abide by the principles set out when dealing with other members of the Practice, patients and anyone with whom we work or are associated howsoever with the Practice. The Practice will comply with the provisions of the Sex Discrimination Act, Race Relations Act, Disability Discrimination Act and Employment Equality (Religion or Belief) Regulations.
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Part 2
1 APPEARANCE AND CONDUCT
As a doctor, you are required to adhere to the standards of professional and personal conduct and probity laid down by the General Medical Council. All doctors at the Practice are bound by these standards. You are also reminded that as an employee, you are in a position of trust and responsibility towards your employers and non-medical Practice staff, as well as patients.
Non-medical staff of the Practice will need to look to you with confidence, particularly in exceptional circumstances when a doctor is required, but none of the partners is available. It is important, therefore, that your conduct is of a high standard.
As with any other member of staff, it is important that your appearance is clean and tidy at all times and that, in general, you maintain personal standards becoming a medical practitioner.
2 CAR PARKING
Provided that space is available you may use one of the designated car parking spaces at [the/each*] surgery while on duty.
3 COMPLAINTS
At some stage, a patient or relative may make a complaint to you about the Practice or you may be the subject of a complaint yourself.
All complaints must be sympathetically received and quickly dealt with, however, minor they might appear to be. They must be referred immediately to [insert details of designated individual responsible for dealing with complaints], “the Complaints Officer”. If the Complaints Officer is unavailable at the time, written notes on the problem should be made and dated and timed. The notes should then be passed on for the attention of the Complaints Officer as quickly as possible. This process should be made clear to the person complaining and s/he should be assured that the Complaints Officer will be in touch with him/her as soon as possible.
If you are named or involved in a complaint, you will be required to assist any Practice investigations into the cause of the complaint by making a verbal or written statement concerning the events and your involvement. Your Trainer/educational supervisor will ensure that any complaints against you are investigated in accordance with the Practice complaints procedure, and if necessary, the Practice disciplinary procedure, set out in Appendix 2 of your contract of employment.
You should be aware of the NHS Executive guidance on Practice Based Complaints procedures, particularly the model guidance for staff appended to it. This guidance and full details of the Practice complaints procedure are available from the Practice Manager.
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4 COMPUTERS (see note h)
The Practice policy in relation to the use of computers is as follows.
In order to minimise the risk of virus infection of computer software staff must not
introduce unauthorised data or programs on to Practice computers. It is essential that only Practice supplied disks or drives are used and no computer material derived from the Practice should be removed from the premises, electronically transferred outside the Practice or installed into other machines without authorisation from your GP Trainer/educational supervisor.
For professional purposes relevant to your employment with the Practice, you
may have access to the Internet and NHS net via the Practice computing system.
Staff may use word processing and email facilities for private use but only when
permission is granted by [insert authorising officer] and to the extent so authorised. Unauthorised use could result in disciplinary action being taken against you.
You will be supplied with a computer password, which will be changed from time
to time. You must not reveal this password to any other person and if you do so, you will be subject to action under the disciplinary procedure. Deliberately giving your password to another person, including other Practice staff other than in accordance with procedures for the security of passwords, will be regarded as gross misconduct.
Any act or misuse that compromises or potentially compromises the integrity of
Practice computer hardware or software, or any attempt to, will be considered as gross misconduct, as will access or download of any pornographic, obscene, illegal or other unacceptable material from the Internet. The Practice reserves the right to access all information maintained on their computer system in order to monitor this policy.
5 CONFIDENTIALITY
All information concerning patients, staff (in connection with their employment) and the Practice business is strictly confidential and must not be disclosed to those who are not entitled to receive it in the course of their duties. A breach of confidentiality constitutes gross misconduct and may result in dismissal, subject to the provisions of the disciplinary procedure.
Non-medical staff in the Practice have received similar guidance on these matters via their contracts and handbooks of terms and conditions of service. In particular, they have been made aware of doctors’ responsibilities in the maintenance of confidentiality and that they should not disclose confidential patient information without the consent of the patient’s doctor.
This general duty of confidentiality does not affect your statutory rights under the Public Interest Disclosure Act 1998, to make disclosures of otherwise confidential information without being dismissed or otherwise subjected to a detriment. However, it is expected
57
that matters you are concerned about should normally be raised within the Practice in the first instance. Such matters (e.g. about the safety of patient care) may be raised with any partner. Protection under the Act applies whether the disclosure is made internally or externally. Further information on the rights granted by the Act may be obtained from the Practice manager, or from the charity Public Concern at Work, at www.pcaw.co.uk.
6 EMPLOYERS’ LIABILITY
The Practice is required under the Employers Liability (Compulsory Insurance) Act 1969 to take out employers’ liability insurance. The insurance policy is displayed on the notice board. You should acquaint yourself with the policy details.
7 FIRE ROUTINES
[named member of staff] has been appointed as a fire steward and is responsible for testing the fire alarm, organising evacuation drills and checking the identities of those evacuated following a fire or other emergency. The fire steward will have received training to enable him/her to carry out the duties associated with the role.
However, fire prevention is the responsibility of every member of staff. It is the duty of everybody to become familiar with the Practice procedures for dealing with a fire and to prevent any potential fire hazards immediately. You should therefore
Study the fire notices placed at various points in your place of work.
Make sure you are able to raise the alarm and identify the fire alarm when it is given.
Know the correct procedure for reporting a fire and to whom it should be reported and know where you yourself are to report.
Familiarise yourself with the various types of fire extinguisher available in the Practice, where they are located and how to operate each type.
Be sure you know the arrangements for the evacuation of patients and staff.
In the event of fire you are not expected to take risks, and for your own safety as well as that of others, if the fire alarm is activated, try to keep calm and do not panic.
You must take steps to ensure that you are properly aware of such matters. Please consult the Fire Steward if you are in any doubt about the fire and fire prevention arrangements.
From time to time the Practice Manager/ [named person] will arrange fire drills in which you are required to participate.
8 FIRST AID
The Practice has its own first aider [identify first aider] and has its own [box/cupboard] for immediate use on the premises. It is located at [ ] and the first aider has been given the responsibility of stocking and checking this facility on a regular basis.
9 GP REGISTRATION: PRACTICE STAFF (see note i)
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You are strongly advised to ensure that you are registered with a GP at all times. Where possible you should be with another practice and a list of GPs in the area is available from the [ ] PCT or from your local library.
10 HEALTH AND SAFETY (see note j)
10.1 The Practice general policy in relation to Health and Safety at work is
To provide adequate control of health and safety risks arising from our
work activities.
To consult with our staff on matters affecting their health and safety.
To provide and maintain safe plant and equipment.
To ensure safe handling and the safe use of substances.
To provide information, instruction and supervision for employees.
To ensure that all employees are competent to do their tasks and to give them adequate training.
To prevent accidents and cases of work-related ill health.
To maintain safe and healthy work conditions.
To review and revise this policy as necessary at regular intervals.
Overall responsibility for health and safety is that of [name].
10.2 Accident or Injury at Work
Any accidents to a member of staff or a member of the public must be reported to the Practice Manager or a Partner immediately. A factual statement covering to the fullest possible extent all the circumstances of the accident is required to ascertain the cause and prevent its recurrence. All reports of accidents to partners, staff and members of the public while on the surgery premises must be recorded in the accident book held in the office.
All employees must:
Cooperate with Partners and Practice Management on health and safety
matters.
Not interfere with anything provided to safeguard their health and safety.
Take reasonable care of their own health and safety.
Report all health and safety concerns to the Practice Manager.
Examples of the main hazards of which staff should be aware are:
Medical instruments and equipment, particularly needles and glass items.
Infected or contaminated blood specimens or other material.
Blood borne viruses.
Certain solutions used for disinfection purposes.
Access to and manual handling of files and patient records.
59
Lifting and provision of other physical assistance to patients.
The use of any electrical equipment, and in particular, autoclaves or hot air ovens used for sterilising instruments.
Spillage.
Prams, bicycles, shopping trolleys, toys.
This list is not exhaustive.
10.3 Good Practice
The following notes on safety are given as general advice only
When working with instruments, equipment or machinery, you should ensure that all safety precautions and procedures are followed, and that equipment is sterilised regularly and always immediately after use. Make sure you know: the correct safe way to perform any job with which you are involved; or any protective clothing should be worn. If in any doubt ask the [named partner]. You may yourself be approached for similar advice by members of non-medical staff. You must not under any circumstances take chances or work under hazardous conditions without any safeguards.
Take note of warning lights that are posted to point our hazards.
Keep supplies and equipment out of corridors, passageways and staircases, wherever possible. After use return supplies and equipment to their proper storage area.
Wear safe footwear and keep it in good repair. A rubber heel can save a fall; leather and metal heel-caps can slide very easily on polished floors. Report trailing wires, cracked or broken floor covering, turned up corners on carpets and similar hazards.
Spillage on the floor is potentially dangerous and should be dealt with appropriately without delay.
Electrical appliances should be turned off when not in use and plugs removed from their sockets, unless otherwise instructed.
All sharps must be placed in British Standard quality disposal containers provided; needles should not be re-sheathed. Syringes should be fully evacuated of drugs and chemicals before disposal and the needle/syringe should be discarded directly into the sharps container as a single unit.
It is the personal responsibility of the individual using a sharp to dispose of it safely. Never leave sharp objects unattended or put them into disposable sacks.
More detailed guidance on safe working practices and procedures designed to minimise risk are contained in the health and safety manual with which you are required to familiarise yourself. It is available from the Practice Manager/ [name
60
of person].
10.4 Occupational Health Service
The Practice has contracted with [ ] to provide an occupational health service for its staff. Any member of staff wishing to use the service should contact [Tel no]. Staff may access the service confidentially, though its use in general will be monitored by the [Practice Manager] on a continuing basis.
11 LOCAL REPRESENTATION
As a GPST in general practice, you are represented by the [name] LMC. The LMC is the statutory representative body for GPs in its area. You may wish to register voluntarily as an LMC constituent. If you do so, you have the right to seek election to the LMC if a seat is available. Payment of the statutory levy made in respect of your membership of the LMC’s constituency will be the responsibility of [the Practice].
This is separate to your right to join or not join a Trade Union referred to in part 1 of the handbook. You can contact the British Medical Association (BMA) at www.bma.org.uk.
12 MEDICAL RECORDS
12.1 Patient Access to Records
Patients (and in certain circumstances, their appointed representatives) have certain statutory rights to have access to their own medical records under the Data Protection Act 1998 and the Access to Medical Reports Act 1988. There are also rights for interested parties to seek access to the records of deceased patients under the Access to Health Records Act 1990.
The first gives patients the right to know whether the doctor holds personal data about them on a computer or in manual records, and the right to be supplied with a copy of the data. These rights are known as ‘subject access’ rights (the subject being the patient). The second gives rights of access by a patient to medical reports, which his/her own doctor has made on request from a third party for employment or insurance purposes. Following the enactment of the Data Protection Act 1998, the third now only applies to manual medical records of deceased patients held by their own doctors. However, this only applies to records created since 1 November 1991. There are important procedures to be followed when applications for access are made under any of these Acts, including time limits for action by you as the patient’s doctor. Guidance on your responsibilities under these Acts is kept in the Practice Manager’s office.
Non-medical staff have been instructed that all applications for access must be referred to the patient’s doctor who is responsible for responding to them.
12.2 Staff Access to Records
Both directly employed Practice staff and attached NHS clinical staff, e.g. health visitor, community nurse, midwife may have access to patient information which is necessary for the effective care of the patient, with the patient’s consent.
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Access is via the reception staff. You must not remove patient records from the Practice premises, except where this is necessary for patient consultations at branch surgeries, outlying clinics, or occasionally, in the patient’s home. When transporting or using patient records you must keep them in your personal custody and return them to the Practice premises where they are normally kept as soon as possible.
Staff who are patients of the Practice may only seek access to their own medical records under the provisions of the Data Protection Act 1998 and the Access to Medical Reports Act 1988. If you are a patient of the Practice and wish to seek access to your own records, you must make a request for access of your own doctor in accordance with the provisions of the relevant Act.
Staff must not attempt to gain access to their own medical records other than as set out above or to those of their own families, or those of their colleagues or their friends.
Access to computerised staff medical records will be barred and written records will be stored separately in a secure place.
12.3 Detailed guidance for doctors on medical records is available from the BMA. The
Freedom of Information Act 2000 includes General Practitioners in the definition of “public authorities”. However, requests for personal information remain covered by the Data Protection Act and are exempt from the Freedom of Information legislation. Any requests for information must be referred to [the Practice manager].
13 PATIENTS
13.1 Accepting New Patients
Provided that our list is not closed, any person who has recently moved into our Practice area may be registered with the Practice. Anyone who is already registered with a doctor in the Practice area and wishes to transfer to the Practice or who lives outside the Practice area will be referred to the Practice Manager or a Partner.
13.2 Appointments
The arrangements in the Practice will be explained to you. Appropriate entries will be made in the appointment book or will be logged on to the computer. If a patient indicates some degree or urgency then arrangements will be made for him or her to consult a doctor at the earliest possible time.
13.3 Home Visits
All requests for home visits will be recorded at the time of receipt in the visiting diary. Requests for home visits may be dealt with at the discretion of the doctor responsible for visiting. Any requests for visits after [1.00 p.m.] will be referred directly to the doctor on-call via the main surgery. (See also section 12 above.)
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13.4 Patients’ Enquiries
Information about their hospital reports and test results will be given only to the patient concerned and only with the permission of a doctor.
13.5 Treatment
Non-medical staff have been instructed that they must not advise on medical issues or prescribe treatments for patients unless they have been authorised to do so by a doctor, and that any such requests must be referred to a doctor, or a nurse as appropriate. Non-medical clinical staff have similarly been instructed that they must undertake only such duties in the treatment of patients as have been properly delegated to them and for which they have been appropriately trained. Items prescribed for, or treatment given to patients must be recorded in their notes.
14 PERSONAL PROPERTY
No responsibility can be taken by the Trainer/educational supervisor or the Practice for the loss of, or damage to articles of personal property (e.g. money, jewellery etc). You are advised not to carry large sums of money around with you, to leave handbags and personal property in a safe place at all times, and to ensure that your personal insurance covers such property.
The Trainer/educational supervisor or the Partners cannot accept responsibility for articles of personal property lost or damaged on their premises whether by burglary, fire, theft or otherwise and you are advised to effect your own insurance cover against all risks.
15 PRACTICE LEAFLETS
The Practice publishes a small factual leaflet containing details of the Partners and doctors employed by them, opening times, surgeries, doctors on-call, special clinics and dispensing arrangements. This leaflet has been made freely available to all patients.
16 PRACTICE MEETINGS
You are required to attend and participate in relevant meetings within the Practice. Your Trainer/educational supervisor will provide details of these. These may occasionally involve attendance outside your normal working hours. If so, you will be paid at your normal rate.
17 PRESCRIPTIONS
No prescription will be issued until it has been checked and signed by a doctor. Receptionists or dispensers may accept written or telephone requests for repeat prescriptions providing the patient is on regular medication and the doctor has authorised it. The maximum period for issuing repeat prescriptions is [six months], unless the patient is seen by his/her doctor.
Members of staff should not prepare or order prescriptions for themselves, their
63
colleagues (unless you, as a colleague’s registered GP, do so, or you do so in any case requiring emergency or immediate necessary treatment) or for members of their families.
18 PRODUCT LIABILITY
The partnership has certain responsibilities when supplying medicines and appliances to patients whether in the surgery treatment room, in emergency consultations or when dispensing. The Practice may be liable in law if the produce being dispensed is defective and damage results from its use in circumstances where the supplier of the produce cannot be identified. You must therefore:
Adhere strictly to the labelling regulations which apply to all dispensed
medicines, and
Comply with the Practice system, which provides for keeping accurate records (invoices etc.) of sources of supply of all products and retaining such records for a period of eleven years.
19 RECORDS
Accurate and complete records are an essential part of good medical practice and it is your responsibility to ensure that such records are maintained on the Practice system. Your Trainer/educational supervisor will be able to advise on any areas about which you are uncertain.
20 SECURITY
20.1 General
In addition to ensuring your personal safety and the security of your own property (see Personal Property above), you can help, for example by:
Making sure that doors to unauthorised areas and safety cupboards are properly shut and/or locked.
Immediate reporting all disruptive or untoward incidents to [ ].
Ensuring that any property or money for which they are responsible is securely held, regularly checked and accounted for.
Ensuring at the end of the working day that all doors, windows and cupboards are securely locked.
Reporting any unexplained disappearance of property or suspected pilfering to [the Practice Manager].
20.2 Keys
Staff whose duties include being entrusted with the custody of keys on their person must not leave them locked up in drawers or cupboards, or entrust them
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to unauthorised personnel, but must personally keep them secure at all times.
20.3 The Building
A member of the Practice staff must always be present in the main surgery from [ am] until [ pm] when the telephone calls are transferred to the duty doctor.
A member of the Practice staff must always be present in the branch surgery from [ am] until [ pm] when the telephone calls are transferred to the duty doctor.
No member of the public is to be allowed on to surgery premises unless a member of staff is present.
Any damage to Practice premises by staff or patients will be reported immediately to the [Practice Manager/doctor on duty] who will record it as appropriate.
20.4 Police
Non-medical staff have been instructed that if a situation arises in the surgery that requires police assistance they should immediately inform a doctor on duty. No member of staff, including yourself as a doctor on duty, should place themselves at risk. Staff have been instructed that they should not normally contact the police themselves, except when a doctor is not available.
20.5 Procedures
The following specific security policies and procedures are in force:
Policy on handling violent and potentially violent patients.
Policy for staff training and self-defence and handling of violent and potentially violent situations.
These are available in the Practice Manager’s office. You are advised to obtain copies of them and read them carefully. The Practice Manager will arrange for you to attend the appropriate training courses.
21 SMOKING (see note l)
Legislation in England, Scotland, Wales and Northern Ireland prohibits smoking in all enclosed public spaces. Smoking is not allowed on any part of the Practice premises.
The Practice policy is to promote good health and to be seen to be doing so. In the interests of your health and that of others, including patients, smoking will not be permitted while you are on duty, away from the surgery visiting patients.
Smoking damages your health and that of others, and is a fire risk. You are not permitted to take informal breaks from work for smoking. Nor are you permitted to smoke within 20 yards of the curtilage of the practice premises during established
65
coffee, tea or lunch breaks.
22
STAFF ROOM
A staff room is available and is located at [
].
23
TELEPHONE AND MAIL
[Include here the Practice arrangements with regard to:
The opening and direction of mail. Patients’ enquiries and where, how and in what circumstances you may be contacted.]
23.1 Telephone and Other Messages
All messages must be recorded in the daybook with date and time of receipt. Failure to record any message and to bring it to the attention of the appropriate doctor will be considered a breach of discipline.
23.2 Mobile Telephone
You will be provided with a mobile telephone for use on Practice business only, or can claim for practice related calls on a personal mobile telephone upon provision of an itemised statement. If using a mobile telephone provided by the practice, the Practice Manager is responsible for ensuring that the telephone is serviced and maintained.
23.3 Business Calls
Telephone calls on Practice business, where exceptionally made from home or elsewhere, will be paid by the Practice. Claims for reimbursement should be presented to the Practice Manager/ [named trainer/educational supervisor] and, for calls made from home, should be accompanied by itemised bill.
23.4 Personal Use of Telephone
The Practice telephone (including any mobile telephone with which you have been issued) should not be used for personal calls except where it is unavoidable. Such calls should be short and (if on a conventional phone) normally within the local area; any calls outside the local area will be charged for and you should therefore notify the Practice Manager.
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NOTES FOR THOSE DRAWING UP THE HANDBOOK
These notes are for those drawing up the Handbook and should not be appended to it.
a) ANNUAL LEAVE (Paragraph 2, part 1 refers)
The wording of this section will need to reflect Practice policy on applying for annual leave together with any local variations on the standard provision for annual land bank holiday leave.
b) SICK LEAVE (Paragraph 3, part 1 refers)
The wording reflects the provisions in the Directions to Health Education England.
c) FAMILY FRIENDLY POLICIES
The wording of the sections on
Dependant leave Parental leave Adoption leave Paternity leave
assumes that the Practice applies minimum statutory provisions. d)
Wording will need to change where the Practice has more beneficial local arrangements.
e) MATERNITY LEAVE (Paragraph 7, part 1 refers)
The wording of this section reflects the provisions of the Schedules to Directions to Health Education England which themselves reflect General Whitley Council provisions. It will need to be amended to reflect any different local arrangements.
f) CARS AND TRANSPORT
Payment of this should reflect the provisions in accordance with the Schedules to Directions to Health Education England and Direction to the National Health Service Litigation Authority (GP Registrars) 2013 (or subsequent) (or equivalent)
g) EQUALITY OF OPPORTUNITY (Paragraph 15, part 1 refers)
This section assumes that the practice has a policy covering such matters. A good practice guides can be found at www.dwp.gov.uk
h) COMPUTERS (Paragraph 4, part 2 refers)
The wording may need to be adjusted in situations where GP Trainees have access to laptop computers, designed to be used outside the practice.
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If staff are to be monitored in respect of their usage of the computer, including email, this must be made clear to them on the system itself.
i) GP REGISTRATION: PRACTICE STAFF (Paragraph 9, part 2 refers)
The requirement on staff to register with a GP elsewhere is designed to avoid the partners having to deal with members of staff as both employees and patients at the same time. Acute conflicts of interest can arise when attempting to resolve problems associated with long-term or repeated sick leave, especially where dismissal is a possibility. Similar difficulties can occur regarding disciplinary processes, especially where these are complicated by the ill health of the staff member concerned.
It is recognised, however, that in some circumstances, e.g. in rural areas, it may not be possible to introduce this rule. BMA members in this situation should seek advice from their local BMA office when associated difficulties arise. It would also be inadvisable to attempt to require current staff who are already on the partners’ lists to register elsewhere.
j) HEALTH AND SAFETY (Paragraph 10, part 2 refers)
It is a statutory requirement under the Health and Safety at work Act for all employers to have a written statement of their policy in relation to Health and Safety at work and this should replace the standard wording suggested which is taken from “An Introduction to Health and Safety for small businesses” available from the Health and Safety Executive www.hsebooks.co.uk
Reference is also made to a Health and Safety Manual which should be prepared following a risk assessment exercise in the Practice. Employees should be referred to this as part of their induction and it is good practice to ask employees to indicate that they have seen and understood its provisions.
A full list of HSE publications (both free and priced) may be obtained from HSE Books, PO Box 1999, Sudbury, Suffolk CO10 2WA (Tel: 01787 881165: Fax 02898 313995; Website www.hsebooks.co.uk Guidance is also available from GPC and from the Department of Health on their website www.doh.gov.uk
k) MATERNITY – HEALTH AND SAFETY ISSUES
Employers are required by law to assess the health and safety in the workplace of employees who are pregnant, who have recently given birth or who are breast-feeding, and who have notified these matters to them. Account needs to be taken not only of such matters as potentially dangerous substances or working procedures, but also, for example, of the risk of infection from patients or clinical samples, physical requirements imposed on the employee in carrying out her work, which affect posture and movement, and the increasing size of the pregnant employee. Further information on potential hazards may be found in the Health and Safety Executive’s publication New and expectant mothers at work: a guide for employers.
Such assessments should be carried out immediately after the employee has notified the employer that she is pregnant or has recently given birth. The employer should explain the assessment and the reason for it to the employee. Once the assessment has been made, action can be taken, if necessary, to determine whether it is possible or
68
necessary to:
Modify the work processes in which the employee is involved, to render them safe for
her to continue working, or
Require her only to undertake those parts of her work which are safe for her to do, or,
if neither of these is possible, offer her suitable alternative work
If none of these is possible, or if she reasonably refuses an offer of alternative work, the employee has the right to be suspended on health and safety grounds on normal pay while her condition and the identified health and safety risk(s) continue. The employer should ensure that the assessment process and any communications about it or arising from it (e.g. offering alternative work or confirming the basis of suspension) are properly documented in the employee’s personal file.
l) MEDICAL RECORDS (Paragraph 12, part 2 refers)
Detailed advice on access to patients’ records is given in Medical certificates and reports produced by the BMA’s General Practitioners’ Committee. This is on the BMA website as is guidance on the Data Protection Act 1998 (and the Freedom of Information Act 2000)
m) SMOKING (Paragraph 21, part 2 refers)
This paragraph assumes the existence of a Practice policy on the promotion of good health, which encompasses the position of the staff in projecting the appropriate image.
Assistance in giving up smoking can also be offered to all staff who are smokers.
The Practice policy should be made clear to new staff throughout the whole of the recruitment process. .
2.50 2.50
0.25 0.25 0.50
1.00 1.00
1.00 1.00
2.50 2.50
0.25 0.25 0.50
2.50
2.50
0.25 0.25 0.50
1.00 1.00
2.50
2.50
0.25 0.25 0.50
2.50 2.50
0.25 0.25 0.50
1.00 1.00
1.00 1.00
3.00 3.00
0.50 2.50 3.00
1.00 1.00
1.00 1.00
4.00 4.00
2.50 2.50
0.25 0.25 0.50
1.00 1.00
1.00 1.00
2.50 2.50
0.25 0.25 0.50
27.75 12.25 40.00
REGISTRAR TIMETABLE Clinical Educational Total
Week Commencing:
MONDAY AM
PM
08:30 - 11:00
11:00 - 11:30
11:30 - 12:30
14:00 - 15:00
15:00 - 17:30
17:30 - 18:00
Surgery
De-brief with Dr A / Dr B / Dr C
Visits (max 2)
Prescriptions / Admin
Surgery
De-brief with Dr A / Dr B / Dr C
TUESDAY AM
PM
08:30 - 11:00
11:00 - 11:30
11:30 - 12:30
15:00 - 17:30
17:30 - 18:00
ON CALL 08:30-12:30 WITH EMERGENCY APPTS
AND SUPPORT FROM GP PARTNER
Surgery
De-brief with Dr A / Dr B / Dr C
Prescriptions / Admin
ON CALL 15:00-18:00 WITH EMERGENCY APPTS
AND SUPPORT FROM GP PARTNER
Surgery
De-brief with Dr A / Dr B / Dr C
WEDNESDAY AM
PM
08:30 - 10:30
10:30 - 11:00
11:00 - 12:00
12:00 - 13:00
14:00 - 17:00
Surgery
De-brief with Dr A / Dr B / Dr C
Prescriptions / Admin
Continuous Professional Development Meeting
Core Teaching
THURSDAY AM
PM
08:30 - 11:30
11:30 - 12:30
12:30 - 13:30
Joint surgery (1hr)/ Tutorial (1hr)/ Viewing videos(1hr)
Visits (max 2)
Prescriptions / Admin
Professional Development Time
FRIDAY AM
PM
08:30 - 11:00
11:00 - 11:30
11:30 - 12:30
14:00 - 15:00
15:00 - 17:30
17:30 - 18:00
Video Surgery
De-brief with Dr A / Dr B / Dr C
Visits (max 2)
Prescriptions / Admin
Surgery
De-brief with Dr A / Dr B / Dr C
PATIENT CONSENT FORM FOR RECORDING CONSULTATIONS FOR TRAINING PURPOSES.
Patient’s Name Place of Recording
Person accompanying patient Date
We are hoping to make recordings of some of the consultations between patients and Dr ……………………………………. whom you are seeing today. The recordings are used by doctors training to be a GP to review their consultations with their trainers. The recording is ONLY of you and the doctor talking together. Intimate examinations will not be recorded and the camera will be switched off on request.
All recordings are carried out according to guidelines issued by the General Medical Council, and will be stored securely in line with the practice guidelines. They will be deleted within one year of the recording taking place.
You do not have to agree to your consultation with the doctor being recorded. If you want the camera turned off, please tell Reception - this is not a problem, and will not affect your consultation in any way. But if you do not mind your consultation being recorded, please sign below. Thank you very much for your help.
TO BE COMPLETED BY PATIENT I have read and understood the above information and give my permission for my consultation to be recorded.
Signature of patient BEFORE CONSULTATION:
.................................................................................... Date ............ .................................
Signature of person accompanying patient to the consultation:
................................................................................... Date ……………………….………
After seeing the doctor I am still willing/I no longer wish my consultation to be used for the above purposes.
Signature of patient AFTER CONSULTATION:
.................................................................................... Date ................................... ..........
Signature of person accompanying patient to the consultation:
................................................................................... Date ……………………….………
1
DBS1
CLAIM FOR REIMBURSEMENT OF RECOGNISED PROFESSIONAL DEFENCE BODY SUBSCRIPTIONS
Details are in S.F.A. paragraph 38.6.v.f
Section 1: To Trainer (To be completed by Trainee)
Trainer Name: Trainer Code: Date:
I wish to make application for reimbursement of my Professional Defence Body subscriptions.
Trainee Name: GMC No:
Dates employed as trainee, from: to:
Organisation subscribed to: Period/(s) I have paid / am paying subscriptions from: to: Amount
from: to: Amount
Amount Claiming Months @ £ per month = £
Months @ £ per month = £
Total claimed in respect of period of general practice traineeship = £
Please reimburse me by monthly instalments of £
I enclose proof of payment of the subscriptions stated (mdu / mps / pdu certificate of payments). I understand that the
costs will not be reimbursed without this.
Yours Sincerely
(Trainee's Signature)
Continued overleaf
DBS1
Section 2: To Primary Care Finance (To be completed by the Trainer)
I acknowledge receipt of the above application and confirm that I shall reimburse my Trainee of the subscription they have paid to become a member of a recognised Professional Defence Body in respect of their current period of General Practice Traineeship.
Payment to my Trainee will be (tick as appropriate):
Practice Stamp
As a lump sum at the start of their traineeship
By equal monthly instalments
(Trainer's Signature)
Section 3: PCF use only
Received Processed:
Payment Made:
Initials
Please return to: Primary Care Financial Services, PO BOX 7091, Leicester, LE5 4WY
Sickness/Absence Form for GPStR Doctors in General Practice
Placements
Please email or post this form to the GPStR Programme Office at the end of each GPStR rotation
Name of Trainee Doctor
Name of Educational Supervisor
GP Practice Address
Name of Practice Manager
Name of Person Completing Form
First day in this GP Placement
Last Day in this GP Placement
It would be expected that approximately one third of the annual entitlement is taken
during each 4-monthly GP placement
From To Total
Annual Leave Dates
Total During Placement
Sickness/Absence
Total During Placement
Other Absence (Please Specify)
PLEASE RETURN TO YOUR LOCAL GP TRAINING PROGRAMME
APPENDIX 11 - INDUCTION TIMETABLE SAMPLE
It can useful to the trainee to add a column describing what you expect the trainee to get from some of the sessions (e.g. sitting in with physiotherapy.
This will partly to be to get to know the staff, but also to learn how to refer, what to refer, how long their waiting list is and how to communicate with
physiotherapists for advice)
Week 1 Week 2
Monday 9.00am – welcome and introductions
(GP Trainer)
10.30am – introduction to computer,
including results (IT admin officer)
11.30am – Coffee/visits (GP Trainer)
2.00pm – Computer training, including data entry, prescribing (GP
IT lead)
9.00am – Sit in on physiotherapy
clinic (Physiotherapist)
11.30 – Coffee/visits (GP Partner)
2.00pm – Understand how
correspondence is managed
(Secretary)
3.00pm – Sit in on afternoon
surgery (GP Partner)
Tuesday 9.00am – Sit in on Cardiovascular
clinic (Practice Nurse)
12.30pm – Half day
9.00am – Out of Hours training
(Local OOH Provider)
12.30pm – Half day
Wednesday 9.00am – Sit in on Diabetic clinic
(Practice Nurse)
11.30am – Coffee/visits (GP Trainer)
2.00pm - GPTP
9.00am – Sit in on morning
surgery (GP Partner)
11.30am – Coffee/visits (GP
Partner)
2.00pm – GPTP
Thursday 9.00am – Visit local pharmacy
(Pharmacist), medicines management
11.30am – Coffee/visits (GP Trainer)
2.00pm – Go through contract of
employment, Health & Safety, etc
(Practice Manager)
9.00am – Shadow Health Visitors
(Health Visitor) 11.30am – Coffee/visits (GP
Trainer)
3.00pm – Sit in on Family
Planning Clinic (FP GP and Practice Nurse)
Friday 9.00am – Sit in on treatment room
(Practice Nurse)
11.30am – Coffee/visits (GP Trainer)
1.30pm – First on call (GP Trainer)
9.00am – Do booked surgery, limited number of patients
(covered by GP Trainer)
11.30am – Coffee/visits (covered
by GP Trainer)
2.00pm – Do booked surgery,
limited number of patients
(covered by GP Trainer)
About HEEM
Health Education East Midlands’ goal is to develop a high quality, safe and sustainable workforce to meet the healthcare needs of the people of the East Midlands.
By working closely with stakeholders, we act as a regional ‘convenor’, bringing people together across NHS, social care and the third sector to deliver the best possible services and outcomes for patients.
HEEM covers the counties of Derbyshire, Leicestershire and Rutland, Lincolnshire, Northamptonshire and Nottinghamshire.
Published April 2015
Health Education East Midlands 1 Mere Way Ruddington Fields Business Park Ruddington Nottingham NG11 6JS
Tel: 0115 823 3300 Email: [email protected]
Visit: www.em.hee.nhs.uk Follow: @EastMidsLETB
